Individual
AMALIE B HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
26491 INVERNESS DR STE 201, SOUTH BEND, IN 46628-9279
(219) 851-3500
Mailing address
26491 INVERNESS DR STE 201, SOUTH BEND, IN 46628-9279
(219) 851-3500
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34006069A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100163580
—
KS
Enumeration date
11/28/2007
Last updated
10/25/2021
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