Provider Demographics
NPI:1265615702
Name:HICKS, LAUREN DEANN (MS CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:DEANN
Last Name:HICKS
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:REDKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:503 COUNTY ROAD 763 N
Mailing Address - Street 2:
Mailing Address - City:BUNA
Mailing Address - State:TX
Mailing Address - Zip Code:77612-5965
Mailing Address - Country:US
Mailing Address - Phone:409-673-3211
Mailing Address - Fax:
Practice Address - Street 1:503 COUNTY ROAD 763 N
Practice Address - Street 2:
Practice Address - City:BUNA
Practice Address - State:TX
Practice Address - Zip Code:77612-5965
Practice Address - Country:US
Practice Address - Phone:409-673-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist