Healthcare Provider Details

I. General information

NPI: 1720901622
Provider Name (Legal Business Name): EMILY HICKS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35401 MISSION DR
ST IGNATIUS MT
59865-7791
US

IV. Provider business mailing address

35401 MISSION DR
ST IGNATIUS MT
59865-7791
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-3525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY-PSY-LIC-6146
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: