MEDICARE: LACIE JORDAN HICKS LCSW

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	1041C0700X	Clinical Social Worker	66266	TX

General Provider Information

NPI Number	:	1255776761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACIE JORDAN HICKS LCSW

Provider Business Mailing Address
First Line	:	5603 OVERBROOK DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-4724
Country	:	US
Telephone Number	:	850-420-3579
Fax Number	:

Provider Business Practice Location Address
First Line	:	6937 N IH 35
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78752-3295
Country	:	US
Telephone Number	:	850-420-3579
Fax Number	:

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

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	07/30/2025

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