Provider Demographics
NPI:1821231382
Name:HICKS, JENNIFER JOAN (MA, BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOAN
Last Name:HICKS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1092
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-1092
Mailing Address - Country:US
Mailing Address - Phone:407-928-4928
Mailing Address - Fax:407-880-4344
Practice Address - Street 1:641 N KEENE RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-5635
Practice Address - Country:US
Practice Address - Phone:321-948-0971
Practice Address - Fax:407-880-4344
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst