Individual
DR. LEONARD A. HICKMAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D, H.S.P.P.
Contact information
Practice address
230 E DAY RD, STE 160, MISHAWAKA, IN 46545-3463
(574) 271-8222
(574) 271-8896
Mailing address
230 E DAY RD, STE 160, MISHAWAKA, IN 46545-3463
(574) 271-8222
(574) 271-8896
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
20040609A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000336157
BLUE CROSS BLUE SHIELD
IN
01
—
20040609A
STATE LICENSE
IN
Enumeration date
06/16/2005
Last updated
07/08/2007
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