Provider Demographics
NPI:1609940329
Name:HICKS, KEN W (LCSW LAT NCAC II SAP)
Entity type:Individual
Prefix:MR
First Name:KEN
Middle Name:W
Last Name:HICKS
Suffix:
Gender:M
Credentials:LCSW LAT NCAC II SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 S JACKSON
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601
Mailing Address - Country:US
Mailing Address - Phone:307-265-2555
Mailing Address - Fax:307-237-1259
Practice Address - Street 1:336 S JACKSON
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-265-2555
Practice Address - Fax:307-237-1259
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLAT157101YA0400X
WYLCSW0111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical