Provider Demographics
NPI:1831599620
Name:HICKS, JENNIFER (LIC AC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 VILLAGE DR W
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-1309
Mailing Address - Country:US
Mailing Address - Phone:609-433-3378
Mailing Address - Fax:
Practice Address - Street 1:31 VILLAGE DR W
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08620-1309
Practice Address - Country:US
Practice Address - Phone:609-433-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00090400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist