Provider Demographics
NPI:1689030546
Name:HICKS, JANELLE
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13506 N MUZZY RD
Mailing Address - Street 2:
Mailing Address - City:NEWMAN LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99025-8473
Mailing Address - Country:US
Mailing Address - Phone:509-954-8446
Mailing Address - Fax:
Practice Address - Street 1:13506 N MUZZY RD
Practice Address - Street 2:
Practice Address - City:NEWMAN LAKE
Practice Address - State:WA
Practice Address - Zip Code:99025-8473
Practice Address - Country:US
Practice Address - Phone:509-954-8446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist