Individual
SALLY HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
302 S MAIN ST, MOUNT PROSPECT, IL 60056
(847) 977-3269
Mailing address
302 S MAIN ST, MOUNT PROSPECT, IL 60056
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EAD832010128
BLUE CROSS BLUE SHIELD
—
Enumeration date
02/10/2021
Last updated
02/10/2021
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