MEDICARE: EMILY HICE

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	10618	TN
2	103K00000X	Behavior Analyst	1-16-24253	TN

General Provider Information

NPI Number	:	1962855965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY HICE

Provider Business Mailing Address
First Line	:	4655 LAUREL OAKS
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-3915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4655 LAUREL OAKS
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-3915
Country	:	US
Telephone Number	:	513-479-9772
Fax Number	:

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

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	01/06/2017

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Directions to “ EMILY HICE ” Practice Location

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