Individual
COREY HICKENBOTTOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
310 W MAIN ST, OTTUMWA, IA 52501-2523
(641) 683-6747
Mailing address
403 W BROADWAY AVE, FAIRFIELD, IA 52556-3234
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
07/21/2025
Last updated
07/21/2025
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