Provider Demographics
NPI:1154587632
Name:PROUTY, VICKI L (CCC/SLP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:PROUTY
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5008
Mailing Address - Country:US
Mailing Address - Phone:972-881-8401
Mailing Address - Fax:
Practice Address - Street 1:5025 ANDOVER DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5008
Practice Address - Country:US
Practice Address - Phone:972-881-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist