Healthcare Provider Details

I. General information

NPI: 1609707421
Provider Name (Legal Business Name): MADISON HICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADISON PICKLE

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S ALMA SCHOOL RD APT 218
MESA AZ
85210-2029
US

IV. Provider business mailing address

825 S ALMA SCHOOL RD APT 218
MESA AZ
85210-2029
US

V. Phone/Fax

Practice location:
  • Phone: 623-307-3605
  • Fax:
Mailing address:
  • Phone: 623-307-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-453085
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: