Provider Demographics
NPI:1487787412
Name:HICKS, SUE BRUNER (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:BRUNER
Last Name:HICKS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 NW 122ND ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1955
Mailing Address - Country:US
Mailing Address - Phone:405-418-7399
Mailing Address - Fax:405-286-2402
Practice Address - Street 1:2932 NW 122ND ST
Practice Address - Street 2:SUITE 14
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1955
Practice Address - Country:US
Practice Address - Phone:405-418-7399
Practice Address - Fax:405-286-2402
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200350740AMedicaid
OK200350740BMedicaid