Provider Demographics
NPI:1871077586
Name:MILLIKEN, KATHERINE HICKS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HICKS
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 FLAT STONE DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7579
Mailing Address - Country:US
Mailing Address - Phone:270-535-8410
Mailing Address - Fax:
Practice Address - Street 1:908 FLAT STONE DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7579
Practice Address - Country:US
Practice Address - Phone:270-535-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113110235Z00000X
NC15067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113110OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION
14288751OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION (ASHA)
NC15067OtherNORTH CAROLINA BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGISTS & AUDIOLOGIST