MEDICARE: JUDY 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1629960034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY HICKS

Provider Business Mailing Address
First Line	:	2701 RUSSELL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2137
Country	:	US
Telephone Number	:	314-598-7636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 RUSSELL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2137
Country	:	US
Telephone Number	:	314-598-7636
Fax Number	:	314-598-7636

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

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	11/11/2025

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