Provider Demographics
NPI:1790242741
Name:HICKS, DANIELLE MEGHAN
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MEGHAN
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MEGHAN
Other - Last Name:HABRAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:432 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2259
Mailing Address - Country:US
Mailing Address - Phone:615-431-9776
Mailing Address - Fax:
Practice Address - Street 1:432 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2259
Practice Address - Country:US
Practice Address - Phone:615-431-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TN7224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7224OtherTN STATE PROVISIONAL LICENSE
RBT-18-55506OtherBACB REGISTRATION NUMBER