MEDICARE: MRS. SHANNON 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	103K00000X	Behavior Analyst	4451	TX

General Provider Information

NPI Number	:	1407510845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON HICKS

Provider Business Mailing Address
First Line	:	15003 HIGHWAY 6 STE 108
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-7371
Country	:	US
Telephone Number	:	281-710-4980
Fax Number	:	346-326-5598

Provider Business Practice Location Address
First Line	:	15003 HIGHWAY 6 STE 108
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-7371
Country	:	US
Telephone Number	:	281-710-4980
Fax Number	:	346-326-5898

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

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	01/13/2026

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