Doctor Name: | JESSICA ANN HICKS |
NPI Number: | 1720419393 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MBA, RD, LDN |
License Number: | 164.006090 |
Business Practice Address: | 2271 Bluewater Dr Wauconda, IL - 600845022 |
Business Phone Number: | 8474923040 |
Business Fax Number: | |
Mailing Address: | 2271 Bluewater Dr, WAUCONDA |
State: | IL |
Postal Code: | 60084 |
Phone Number: | 8474923040 |
Fax Number: | |
NPI Enumeration Date: | 12/09/2013 |
NPI Last Update Date: | 12/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133VN1006X |
License Number: | 164.006090 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | Nutrition, Metabolic |
Taxonomy Definition: |