Individual
KAYLA JAYNE HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPCC, LADC
Contact information
Practice address
2864 MIDDLE ST STE 100, LITTLE CANADA, MN 55117-1411
(651) 493-2055
Mailing address
531 ESK LN, EAGAN, MN 55123-3911
(218) 340-7526
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304932
MN
101YP2500X
Professional Counselor
Primary
2540
MN
Other
Enumeration date
03/04/2021
Last updated
03/04/2021
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