Healthcare Provider Details

I. General information

NPI: 1346428794
Provider Name (Legal Business Name): KARA LYNN HICKS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 01/22/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NW CORPORATE BLVD STE 300
BOCA RATON FL
33431-7307
US

IV. Provider business mailing address

201 W BROADWAY STE F
COLUMBIA MO
65203-3842
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-6090
  • Fax:
Mailing address:
  • Phone: 573-214-0436
  • Fax: 573-442-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2015022731
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0900016
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: