Active NPI
Kenneth Hicks, M.A., LCSW
- Clinical Social Worker
- Gary, IN
National Provider Identifier
1881719532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 308 East 21St Avenue
Gary, IN 46407 - Phone
- (219) 886-1320
- Fax
- (219) 886-1319
- NPI assigned
- Mar 20, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | IL | Primary |
Addresses
Primary practice location
308 East 21St Avenue
Gary, IN 46407
Mailing address
9323 South Emerald Avenue
Chicago, IL 60620
Phone (773) 858-6999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.005869 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881719532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9323 SOUTH EMERALD AVENUE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60620",
"telephone_number": "773-858-6999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 EAST 21ST AVENUE",
"city": "GARY",
"state": "IN",
"postal_code": "46407",
"telephone_number": "219-886-1320",
"fax_number": "219-886-1319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "KENNETH",
"credential": "M.A., LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gary, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.