Provider Demographics
NPI:1861226458
Name:HICKOK, CASSANDRA MONIQUE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MONIQUE
Last Name:HICKOK
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 1:44 S MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2902
Mailing Address - Country:US
Mailing Address - Phone:626-795-9127
Mailing Address - Fax:
Practice Address - Street 1:44 S MENTOR AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2902
Practice Address - Country:US
Practice Address - Phone:626-795-9127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373H00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172V00000XOther Service ProvidersCommunity Health Worker