MEDICARE: MRS. VICKI HICKMAN MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP 5506	OH

General Provider Information

NPI Number	:	1326460296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKI HICKMAN MA, CCC-SLP

Provider Business Mailing Address
First Line	:	65553 WINTERGREEN RD
Second Line	:
City	:	LORE CITY
State	:	OH
Zip	:	43755-9715
Country	:	US
Telephone Number	:	740-489-5100
Fax Number	:	740-489-9049

Provider Business Practice Location Address
First Line	:	65553 WINTERGREEN RD
Second Line	:
City	:	LORE CITY
State	:	OH
Zip	:	43755-9715
Country	:	US
Telephone Number	:	740-489-5100
Fax Number	:	740-489-9049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	01/13/2014

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Directions to “ MRS. VICKI HICKMAN MA, CCC-SLP” Practice Location

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