| Sue Hicks Llc | |
|
4477 W Emerald St Ste C275 Boise ID 83706-2078 | |
| (208) 740-0391 | |
| Not Available |
| Full Name | Sue Hicks Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4477 W Emerald St Ste C275, Boise, Idaho |
| Authorized Official Name and Position | Sue M Hicks (OWNER) |
| Authorized Official Contact | 2087400391 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sue Hicks Llc 5524 S Caper Pl Boise ID 83716-6929 Ph: (208) 740-0391 | Sue Hicks Llc 4477 W Emerald St Ste C275 Boise ID 83706-2078 Ph: (208) 740-0391 |
| NPI Number | 1124619978 |
|---|---|
| Provider Enumeration Date | 02/02/2021 |
| Last Update Date | 02/02/2021 |
| Certification Date | 02/02/2021 |
| Medicare PECOS PAC ID | 2163821679 |
|---|---|
| Medicare Enrollment ID | O20210602002326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124619978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Sue Marie Hicks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023028990 PECOS PAC ID: 6507296761 Enrollment ID: I20200501000239 |
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