Healthcare Provider Details

I. General information

NPI: 1801140876
Provider Name (Legal Business Name): DEBORAH L. HICKEY, D.O.PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6512-20TH ST CT W #C
FIREREST WA
98466-6212
US

IV. Provider business mailing address

6512 20TH ST CT W #C
FIREREST WA
98466-6212
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-6809
  • Fax: 253-565-5899
Mailing address:
  • Phone: 253-565-6809
  • Fax: 253-565-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOP00001520
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberOP00001520
License Number StateWA

VIII. Authorized Official

Name: DEBORAH L HICKEY
Title or Position: DO
Credential:
Phone: 253-565-6809