Provider Demographics
NPI:1811323397
Name:HICKS, SUSAN LOUISE
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LOUISE
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LOUISE
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:724 S. CENTRAL, SUITE 101
Mailing Address - Street 2:FAMILY SOLUTIONS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-776-5793
Mailing Address - Fax:541-776-5798
Practice Address - Street 1:4434 COREY ROAD
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502
Practice Address - Country:US
Practice Address - Phone:541-973-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst