Healthcare Provider Details

I. General information

NPI: 1578765145
Provider Name (Legal Business Name): GREGORY A HICKEL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N HIRSCH AVE
ELLINWOOD KS
67526-1433
US

IV. Provider business mailing address

900 W BROADWAY ST
NEWTON KS
67114-2037
US

V. Phone/Fax

Practice location:
  • Phone: 620-564-3069
  • Fax: 620-564-3069
Mailing address:
  • Phone: 316-283-1950
  • Fax: 316-283-9540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW 1925
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: