Provider Demographics
NPI:1629467584
Name:HICKS, KATHY (MA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 HAUSER ROSS DR
Mailing Address - Street 2:225
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3148
Mailing Address - Country:US
Mailing Address - Phone:815-758-8400
Mailing Address - Fax:815-758-8441
Practice Address - Street 1:2540 HAUSER ROSS DR
Practice Address - Street 2:225
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3148
Practice Address - Country:US
Practice Address - Phone:815-758-8400
Practice Address - Fax:815-758-8441
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional