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NPI Code Detail

MEDICARE: DEBRA A HICKMON CACD III

MEDICARE: DEBRA A HICKMON CACD III
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1956WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111103OTHERWIDEAN HEALTH PLANS
239396200OTHERWIHIRSP
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063440618
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA A HICKMON CACD III
Provider Business Mailing Address
First Line : 200 W ALONA LN
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2202
Country : US
Telephone Number : 608-723-6357
Fax Number : 608-723-4417
Provider Business Practice Location Address
First Line : 200 W ALONA LN
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2202
Country : US
Telephone Number : 608-723-6357
Fax Number : 608-723-4417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 07/07/2008

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Directions to “ DEBRA A HICKMON CACD III” Practice Location

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