Provider Demographics
NPI:1801053350
Name:HICKS, DAVID SHELBY (MA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SHELBY
Last Name:HICKS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 SUMMIT ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3482
Mailing Address - Country:US
Mailing Address - Phone:510-465-3067
Mailing Address - Fax:
Practice Address - Street 1:2961 SUMMIT ST
Practice Address - Street 2:SUITE #2
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3482
Practice Address - Country:US
Practice Address - Phone:510-465-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU542231H00000X
CAHA1224231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA1224OtherDEPARTMENT OF CONSUMER AFFAIRS, HEARING AID DISPENSERS BUREAU
CAAU542OtherSPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY BOARD