Individual
DERETHA HICKS-SYKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
904 S 10TH ST, SAINT JOSEPH, MO 64503-2405
(816) 233-5188
(816) 232-2696
Mailing address
2303 VILLAGE DR, SAINT JOSEPH, MO 64506-4954
(816) 271-8219
(816) 232-2696
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2004033766
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033364872
—
MO
01
—
F29A00013
MEDICARE PTAN
—
Enumeration date
11/20/2008
Last updated
06/18/2009
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