Provider Demographics
NPI:1174710172
Name:HICKMAN, JANNAVIE DAWN (MA)
Entity type:Individual
Prefix:
First Name:JANNAVIE
Middle Name:DAWN
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JANNAVIE
Other - Middle Name:DAWN
Other - Last Name:CROGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:6765 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8984
Mailing Address - Country:US
Mailing Address - Phone:530-622-5551
Mailing Address - Fax:530-622-5800
Practice Address - Street 1:6765 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8984
Practice Address - Country:US
Practice Address - Phone:530-622-5551
Practice Address - Fax:530-622-5800
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic