Provider Demographics
NPI:1184172389
Name:HICKLE, PATRICIA (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:HICKLE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 EASTBROOK ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-7801
Mailing Address - Country:US
Mailing Address - Phone:303-514-2556
Mailing Address - Fax:
Practice Address - Street 1:3450 EASTBROOK ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-7801
Practice Address - Country:US
Practice Address - Phone:303-514-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11958225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist