Individual
MISS TINA MARIE HICKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
647 S PRAIRIE ST, JACKSONVILLE, IL 62650-2870
(217) 245-5095
(217) 245-5095
Mailing address
647 S PRAIRIE ST, JACKSONVILLE, IL 62650-2870
(217) 245-5095
(217) 245-5095
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
07/18/2011
Last updated
07/18/2011
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