Provider Demographics
NPI:1962227132
Name:SPANN, VIKKI Y (PHD, SLP-CCC)
Entity type:Individual
Prefix:DR
First Name:VIKKI
Middle Name:Y
Last Name:SPANN
Suffix:
Gender:F
Credentials:PHD, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MS
Mailing Address - Zip Code:38774-0123
Mailing Address - Country:US
Mailing Address - Phone:662-545-7243
Mailing Address - Fax:
Practice Address - Street 1:905 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MS
Practice Address - Zip Code:38774
Practice Address - Country:US
Practice Address - Phone:662-545-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist