Individual
EPIPHANY HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
945 NW NAITO PKWY APT 535, PORTLAND, OR 97209-4718
(678) 933-3944
Mailing address
1615 NE FREMONT ST, PORTLAND, OR 97212-2336
(503) 560-5089
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
08/31/2017
Last updated
08/31/2017
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