Provider Demographics
NPI:1932411469
Name:BABCOCK, VICKY
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9751 N GOVERNMENT WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9645
Mailing Address - Country:US
Mailing Address - Phone:208-772-0964
Mailing Address - Fax:208-772-7936
Practice Address - Street 1:9751 N GOVERNMENT WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9645
Practice Address - Country:US
Practice Address - Phone:208-772-0964
Practice Address - Fax:208-772-7936
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-371237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002656800Medicaid