Provider Demographics
NPI:1720307697
Name:HICKMAN, ROSANNE (RN, BSN, MA, LPC)
Entity type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:RN, BSN, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 W BROAD ST
Mailing Address - Street 2:LOWER LIGHTS CHRISTIAN HEALTH CENTER
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222
Mailing Address - Country:US
Mailing Address - Phone:614-274-1455
Mailing Address - Fax:614-274-2040
Practice Address - Street 1:1160 W BROAD ST
Practice Address - Street 2:LOWER LIGHTS CHRISTIAN HEALTH CENTER
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222
Practice Address - Country:US
Practice Address - Phone:614-274-1455
Practice Address - Fax:614-274-2040
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0000155101YP2500X
OHRN.143545-COA1163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200008Medicaid
OH0200008Medicaid