Provider Demographics
NPI:1043298912
Name:HICKS, CANDACE (PHD)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:SUITE 2A300
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-5678
Practice Address - Fax:806-743-5670
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51432231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100650860AMedicaid
TX144207101Medicaid
NMA4832Medicaid
NM201032260OtherPRESBYTERIAN COMMERCIAL
NM201032260Medicaid
TX80353AOtherBC/BS
TX87794ZOtherHMO BLUE
NMA511OtherTRIWEST
TX144207101Medicaid
TX87794ZOtherHMO BLUE
TX80353AOtherBC/BS