Provider Demographics
NPI:1437968443
Name:HICKS, JORDIAN
Entity type:Individual
Prefix:
First Name:JORDIAN
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N LITCHFIELD RD STE 260
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1369
Mailing Address - Country:US
Mailing Address - Phone:623-337-2275
Mailing Address - Fax:623-800-7626
Practice Address - Street 1:250 N LITCHFIELD RD STE 260
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1369
Practice Address - Country:US
Practice Address - Phone:623-337-2275
Practice Address - Fax:623-800-7626
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW22389104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty