MEDICARE: SHERRI HICKS LCSW

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	104100000X	Social Worker	15469	AZ
2	1041C0700X	Clinical Social Worker	18147	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	843407923	OTHER	AZ	IRS

General Provider Information

NPI Number	:	1801333687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRI HICKS LCSW

Provider Business Mailing Address
First Line	:	2152 S VINEYARD STE 110
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6881
Country	:	US
Telephone Number	:	480-241-9824
Fax Number	:

Provider Business Practice Location Address
First Line	:	2152 S VINEYARD
Second Line	:	STE. 110
City	:	MESA
State	:	AZ
Zip	:	85210-6881
Country	:	US
Telephone Number	:	480-241-9824
Fax Number	:

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

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	11/09/2019

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Directions to “ SHERRI HICKS LCSW” Practice Location

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