Provider Demographics
NPI:1407016959
Name:HICKERSON, CATHERINE ANN (LMT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ANN
Other - Last Name:HICKERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1398 MITCHELL TRL
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3205
Mailing Address - Country:US
Mailing Address - Phone:708-370-7708
Mailing Address - Fax:708-457-1333
Practice Address - Street 1:7830 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-3267
Practice Address - Country:US
Practice Address - Phone:708-370-7708
Practice Address - Fax:708-457-1333
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227-007431225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist