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Contact Information

ETHEL W HETRICK, PhD
412 HIGHWAY 90
SUITE 10
BAY SAINT LOUIS, MS39520-3534
 Phone: 228-467-2424
 Fax: 228-467-5757
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
 

Clinical Neuropsychologist

103G00000X
Indicates primary specialty

NPI Profile & details for ETHEL W HETRICK · (Female)

NPI Number 1699968453
Status Active
Credentials PhD
Entity Individual
Enumeration date 08/23/2007
Last updated 06/24/2014 - About 12 years ago
Sole proprietor 1 Yes
Identifiers
  • MS License # 45 740
  • MS Medicaid 02628066
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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