Provider Demographics
NPI:1982595708
Name:HICKS, VICTORIA L (MS, CADC, QIDP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:HICKS
Suffix:
Gender:F
Credentials:MS, CADC, QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 N DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2507
Mailing Address - Country:US
Mailing Address - Phone:309-351-5173
Mailing Address - Fax:
Practice Address - Street 1:1289 WINDHAM PKWY
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1763
Practice Address - Country:US
Practice Address - Phone:630-759-0937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst