Provider Demographics
NPI:1891559704
Name:VICKERY SPEECH & LANGUAGE
Entity type:Organization
Organization Name:VICKERY SPEECH & LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-241-8502
Mailing Address - Street 1:107 SACRED HEART LN
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1403
Mailing Address - Country:US
Mailing Address - Phone:410-241-8502
Mailing Address - Fax:
Practice Address - Street 1:107 SACRED HEART LN
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1403
Practice Address - Country:US
Practice Address - Phone:410-241-8502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech