Individual
IDELLA MARIE HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4183 WAYLAND CT, INKSTER, MI 48141-2818
(330) 951-9865
Mailing address
4183 WAYLAND CT, INKSTER, MI 48141-2818
(330) 951-9865
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
01/07/2021
Last updated
01/07/2021
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