Provider Demographics
NPI:1982433967
Name:HICKS, LAWANDA L (RECREATION THERAPIST)
Entity type:Individual
Prefix:
First Name:LAWANDA
Middle Name:L
Last Name:HICKS
Suffix:
Gender:F
Credentials:RECREATION THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 I 45 N APT 21101
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2324
Mailing Address - Country:US
Mailing Address - Phone:979-328-7462
Mailing Address - Fax:
Practice Address - Street 1:231 I 45 N APT 21101
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2324
Practice Address - Country:US
Practice Address - Phone:979-328-7462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist