Provider Demographics
NPI:1699265231
Name:VAIL, DEVON PATRICIA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:PATRICIA
Last Name:VAIL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 PARSONS DR APT C
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-4362
Mailing Address - Country:US
Mailing Address - Phone:805-824-0301
Mailing Address - Fax:
Practice Address - Street 1:941 PARSONS DR APT C
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-4362
Practice Address - Country:US
Practice Address - Phone:805-824-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist