Provider Demographics
NPI:1306174149
Name:DOMASCHK, VICKIE (MA)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:DOMASCHK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10804 HUFFMEISTER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3177
Mailing Address - Country:US
Mailing Address - Phone:281-477-9500
Mailing Address - Fax:281-477-9563
Practice Address - Street 1:10804 HUFFMEISTER RD
Practice Address - Street 2:SUITE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3177
Practice Address - Country:US
Practice Address - Phone:281-477-9500
Practice Address - Fax:281-477-9563
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11520235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist