Provider Demographics
NPI:1922454370
Name:HICKERSON, JULIE BARTLETT (MS, BCBA, LB)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:BARTLETT
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:MS, BCBA, LB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28081 N WELTON PL
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5859
Mailing Address - Country:US
Mailing Address - Phone:916-397-4045
Mailing Address - Fax:
Practice Address - Street 1:28081 N WELTON PL
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5859
Practice Address - Country:US
Practice Address - Phone:916-397-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000622103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst