MEDICARE: LELA ROSE 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	175T00000X	Peer Specialist	APS.007309	OH

General Provider Information

NPI Number	:	1467311894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LELA ROSE HICKS

Provider Business Mailing Address
First Line	:	4513 NEW MARKET CT
Second Line	:
City	:	BATAVIA
State	:	OH
Zip	:	45103-1392
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7593 TYLERS PLACE BLVD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6308
Country	:	US
Telephone Number	:	513-714-3400
Fax Number	:

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “ LELA ROSE HICKS ” Practice Location

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