Provider Demographics
NPI:1316168933
Name:VINING, VICKI LYNN PERRYMAN (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN PERRYMAN
Last Name:VINING
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 BERMUDA DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4001
Mailing Address - Country:US
Mailing Address - Phone:505-271-1604
Mailing Address - Fax:
Practice Address - Street 1:4001 BERMUDA DRIVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-4001
Practice Address - Country:US
Practice Address - Phone:505-271-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist