Active NPI
Jennifer Hicks, LCSW
- Social Worker
- Wagoner, OK
National Provider Identifier
1669920054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 901 S. Harrill Ave
Wagoner, OK 74467-5867 - Phone
- (918) 485-0242
- Fax
- (918) 485-0204
- NPI assigned
- Sep 14, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 7277 | OK | |
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
901 S. Harrill Ave
Wagoner, OK 74467-5867
Mailing address
1203 SE 3Rd St
Wagoner, OK 74467-5823
Phone (918) 815-9863
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210301002750 | OK | Practitioner - Clinical Social Worker | 8123434073 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7277 | OK | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710460800000",
"number": "1669920054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1203 SE 3RD ST",
"city": "WAGONER",
"state": "OK",
"postal_code": "744675823",
"telephone_number": "918-815-9863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 S. HARRILL AVE",
"city": "WAGONER",
"state": "OK",
"postal_code": "744675867",
"telephone_number": "918-485-0242",
"fax_number": "918-485-0204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "JENNIFER",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-14",
"last_updated": "2024-03-15",
"certification_date": "2024-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OK",
"license": "7277",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wagoner, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.