Individual
JACQUELYN SUZANNE HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
351 COVENTRY LN, MASON, MI 48854-1162
(517) 604-8083
Mailing address
351 COVENTRY LN, MASON, MI 48854-1162
(517) 604-8083
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401223031
MI
Other
Enumeration date
08/03/2020
Last updated
01/22/2024
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