Provider Demographics
NPI:1942062294
Name:HICKMAN, SHALANDA MICHELLE (RBT)
Entity Type:Individual
Prefix:
First Name:SHALANDA
Middle Name:MICHELLE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:SHALANDA
Other - Middle Name:MICHELLE
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:4000 S EASTERN AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0847
Mailing Address - Country:US
Mailing Address - Phone:702-848-1696
Mailing Address - Fax:
Practice Address - Street 1:4000 S EASTERN AVE STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0847
Practice Address - Country:US
Practice Address - Phone:702-848-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT3896103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst