Individual
THOMAS V HICKS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D., L.P.
Contact information
Practice address
900 AMERICAN BLVD E, SUITE 201, BLOOMINGTON, MN 55420-1392
(952) 854-2622
(952) 854-3293
Mailing address
900 AMERICAN BLVD E, SUITE 201, BLOOMINGTON, MN 55420-1392
(952) 854-2622
(952) 854-3293
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 4530
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057G8HI
BC/BS PROVIDER NUMBER
MN
01
—
112341
HEALTHPARTNERS PROVIDER #
MN
01
—
61-94690
MEDICA PROVIDER NUMBER
MN
Enumeration date
05/25/2006
Last updated
07/08/2007
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