Provider Demographics
NPI:1538587738
Name:HICKS, SARAH LINN (LMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LINN
Last Name:HICKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94021 HOLLOW STUMP LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-8570
Mailing Address - Country:US
Mailing Address - Phone:541-404-6080
Mailing Address - Fax:541-756-4042
Practice Address - Street 1:1957 THOMPSON RD
Practice Address - Street 2:SUITE 208 & 209
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2031
Practice Address - Country:US
Practice Address - Phone:541-404-6080
Practice Address - Fax:541-756-4042
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16446174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist