Provider Demographics
NPI:1861515348
Name:HICKS, GRETCHEN SPRING (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:SPRING
Last Name:HICKS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 E SARDIS RD
Mailing Address - Street 2:
Mailing Address - City:HENSLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72065-9366
Mailing Address - Country:US
Mailing Address - Phone:501-888-5252
Mailing Address - Fax:870-534-7162
Practice Address - Street 1:912 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-4033
Practice Address - Country:US
Practice Address - Phone:870-534-0135
Practice Address - Fax:870-534-7162
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist