MEDICARE: DR. SAMANTHA M HICKMAN PSYD

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	103TC0700X	Clinical Psychologist	071007802	IL

General Provider Information

NPI Number	:	1952633778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA M HICKMAN PSYD

Provider Business Mailing Address
First Line	:	1555 NAPERVILLE WHEATON RD STE 206C
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-1558
Country	:	US
Telephone Number	:	630-480-4408
Fax Number	:	630-447-0047

Provider Business Practice Location Address
First Line	:	1555 NAPERVILLE WHEATON RD STE 206C
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-1558
Country	:	US
Telephone Number	:	630-480-4408
Fax Number	:	630-447-0047

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

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	10/01/2019

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