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Individual

GLENN HICKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CSFA

Contact information

Practice address
2125 STATE ST STE 6, NEW ALBANY, IN 47150-4972
(812) 949-5790
Mailing address
5200 COMMERCE CROSSINGS DR FL 3, LOUISVILLE, KY 40229-2182
(502) 253-4924

Taxonomy

Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
157916
IN
246ZS0410X
Surgical Technologist
95136
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
95136
CST CERTIFICATION
IN
Enumeration date
08/11/2006
Last updated
05/31/2022
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