Individual
DEBRA A HICKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CACD III
Contact information
Practice address
200 W ALONA LN, LANCASTER, WI 53813-2202
(608) 723-6357
(608) 723-4417
Mailing address
200 W ALONA LN, LANCASTER, WI 53813-2202
(608) 723-6357
(608) 723-4417
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1956
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11103
DEAN HEALTH PLANS
WI
01
—
39396200
HIRSP
WI
05
—
39396200
—
WI
Enumeration date
06/30/2006
Last updated
07/07/2008
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