Provider Demographics
NPI:1790190346
Name:HICKEY, COLLEEN N (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:N
Last Name:HICKEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0523
Mailing Address - Country:US
Mailing Address - Phone:409-772-2711
Mailing Address - Fax:409-747-2185
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0523
Practice Address - Country:US
Practice Address - Phone:409-772-2711
Practice Address - Fax:409-747-2185
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108804235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist