Provider Demographics
NPI:1194265967
Name:HICKS, LEONORE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEONORE
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 WESTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5106
Mailing Address - Country:US
Mailing Address - Phone:214-733-3936
Mailing Address - Fax:
Practice Address - Street 1:5805 COIT RD STE 403
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6990
Practice Address - Country:US
Practice Address - Phone:972-964-1500
Practice Address - Fax:972-964-1200
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist