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NPI Code Detail

MEDICARE: DR. ELIZABETH L HICKMAN PHD PSY

MEDICARE: DR. ELIZABETH L HICKMAN PHD PSY
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
1103T00000XPsychologistPSY2565CO

General Provider Information

NPI Number : 1437114428
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH L HICKMAN PHD PSY
Provider Business Mailing Address
First Line : 211 W MAIN ST
Second Line :
City : STERLING
State : CO
Zip : 80751
Country : US
Telephone Number : 970-522-4549
Fax Number : 970-522-9544
Provider Business Practice Location Address
First Line : 215 SOUTH ASH
Second Line :
City : YUMA
State : CO
Zip : 80759
Country : US
Telephone Number : 970-848-5412
Fax Number : 970-848-2414
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 07/16/2007

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