Provider Demographics
NPI:1588942510
Name:HICKEY STURM, DEIRDRE (BCBA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:HICKEY STURM
Suffix:
Gender:F
Credentials:BCBA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 EMERY ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5034
Mailing Address - Country:US
Mailing Address - Phone:831-345-1473
Mailing Address - Fax:
Practice Address - Street 1:607 EMERY ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5034
Practice Address - Country:US
Practice Address - Phone:831-345-1473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11876235Z00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty