Provider Demographics
NPI:1629897897
Name:HICKS, MACEY LEE
Entity type:Individual
Prefix:MISS
First Name:MACEY
Middle Name:LEE
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 1:760 WILLOW DALE ST NW
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-9219
Mailing Address - Country:US
Mailing Address - Phone:330-705-1073
Mailing Address - Fax:
Practice Address - Street 1:567 WABASH AVE NW
Practice Address - Street 2:
Practice Address - City:NEW PHILA
Practice Address - State:OH
Practice Address - Zip Code:44663-4143
Practice Address - Country:US
Practice Address - Phone:330-343-3050
Practice Address - Fax:330-343-3150
Is Sole Proprietor?:No
Enumeration Date:2024-10-05
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator