Doctor Name: | KRISTA HICKMAN |
NPI Number: | 1710391628 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., NCSP, SP408 |
License Number: | SP408 |
Business Practice Address: | 1605-a Airport Rd New Lexington, OH - 437641407 |
Business Phone Number: | 7403424133 |
Business Fax Number: | |
Mailing Address: | 1858 Brandigen Ln, COLUMBUS |
State: | OH |
Postal Code: | 432283883 |
Phone Number: | 6142708910 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2014 |
NPI Last Update Date: | 06/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | SP408 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |