Provider Demographics
NPI:1710694278
Name:HICKS, QUEEN ESTHER
Entity Type:Individual
Prefix:
First Name:QUEEN
Middle Name:ESTHER
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 1:3072 DECAMP RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-1244
Mailing Address - Country:US
Mailing Address - Phone:216-253-5605
Mailing Address - Fax:
Practice Address - Street 1:3072 DECAMP RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-1244
Practice Address - Country:US
Practice Address - Phone:216-253-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach