MEDICARE: MRS. JEWELL PATRICIA HICKMAN LPC

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	101YM0800X	Mental Health Counselor	2002010842	MO
2	101YP2500X	Professional Counselor	2002010842	MO

General Provider Information

NPI Number	:	1487628491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEWELL PATRICIA HICKMAN LPC

Provider Business Mailing Address
First Line	:	9800 EDGEFIELD DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-5419
Country	:	US
Telephone Number	:	314-503-2696
Fax Number	:	314-344-0983

Provider Business Practice Location Address
First Line	:	11138 OLD SAINT CHARLES RD
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-2113
Country	:	US
Telephone Number	:	314-344-0983
Fax Number	:	314-344-0983

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	09/11/2025

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