MEDICARE: KATHLEEN HICKS

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
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1184484479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN HICKS

Provider Business Mailing Address
First Line	:	8566 GOLDEN VALLEY DR
Second Line	:
City	:	MAPLE FALLS
State	:	WA
Zip	:	98266-8205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8566 GOLDEN VALLEY DR
Second Line	:
City	:	MAPLE FALLS
State	:	WA
Zip	:	98266-8205
Country	:	US
Telephone Number	:	564-565-8957
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	03/21/2024

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Directions to “ KATHLEEN HICKS ” Practice Location

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