Individual
JASON DAVID HICKMOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3624 216TH ST, MATTESON, IL 60443-2713
(815) 274-4879
Mailing address
9130 W 140TH ST APT 2SE, ORLAND PARK, IL 60462-2147
(815) 922-5021
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178014133
IL
Other
Enumeration date
09/15/2018
Last updated
09/15/2018
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