Provider Demographics
NPI:1720283369
Name:HICKEY, REBECCA S (MS/CCC,SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:HICKEY
Suffix:
Gender:F
Credentials:MS/CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 TALLY HO CT
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-4446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 E. FIRMIN STREET
Practice Address - Street 2:SUITE 178
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6403
Practice Address - Country:US
Practice Address - Phone:765-203-1405
Practice Address - Fax:765-600-2199
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002463A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist