Provider Demographics
NPI:1871897140
Name:HICKMAN, KATHRYN GAYLE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GAYLE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 FOUNTAIN VALLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-2251
Mailing Address - Country:US
Mailing Address - Phone:508-776-3941
Mailing Address - Fax:
Practice Address - Street 1:6155 FOUNTAIN VALLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-2251
Practice Address - Country:US
Practice Address - Phone:508-776-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist