Provider Demographics
NPI:1184484479
Name:HICKS, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8566 GOLDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98266-8205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8566 GOLDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:MAPLE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98266-8205
Practice Address - Country:US
Practice Address - Phone:564-565-8957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider