Provider Information for 1205404191
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KRISTEN HICKS LISW
Sex: Female
NPI: 1205404191
Last Updated: 2021-06-16
Certification Date: 2021-06-16
Certification Date: 2021-06-16
Details
| Name | Value | ||||||||||||||
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| NPI | 1205404191 | ||||||||||||||
| Enumeration Date | 2021-06-16 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 2125 SUMMIT VIEW RD POWELL, OH 43065-8876 United States Phone: 937-572-2649 | Fax: | ||||||||||||||
| Primary Practice Address | 2125 SUMMIT VIEW RD POWELL, OH 43065-8876 United States Phone: 937-572-2649 | Fax: | ||||||||||||||
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