MEDICARE: SANDY NICHELE HICKS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1558639518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY NICHELE HICKS

Provider Business Mailing Address
First Line	:	3925 N. MARTIN LUTHER KING BLVD
Second Line	:	208
City	:	NLV
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	702-265-7651
Fax Number	:	702-685-7408

Provider Business Practice Location Address
First Line	:	3925 N. MARTIN LUTHER KING BLVD
Second Line	:	208
City	:	NLV
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	702-265-7651
Fax Number	:	702-685-7408

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

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	12/06/2011

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Directions to “ SANDY NICHELE HICKS ” Practice Location

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