Provider Demographics
NPI:1104076181
Name:HICKS, NICOLE WHITE (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:WHITE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 SYCAMORE DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-3415
Mailing Address - Country:US
Mailing Address - Phone:910-487-1832
Mailing Address - Fax:910-487-6950
Practice Address - Street 1:3637 SYCAMORE DAIRY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3415
Practice Address - Country:US
Practice Address - Phone:910-487-1832
Practice Address - Fax:910-487-6950
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413131Medicaid