Provider Demographics
NPI:1952633778
Name:HICKMAN, SAMANTHA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:M
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 NAPERVILLE WHEATON RD STE 206C
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1558
Mailing Address - Country:US
Mailing Address - Phone:630-480-4408
Mailing Address - Fax:630-447-0047
Practice Address - Street 1:1555 NAPERVILLE WHEATON RD STE 206C
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1558
Practice Address - Country:US
Practice Address - Phone:630-480-4408
Practice Address - Fax:630-447-0047
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007802103TC0700X
IN20042369A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical