Provider Demographics
NPI:1003217035
Name:VICKERY, ROBERT E (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:VICKERY
Suffix:
Gender:M
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 1:4227 W 111TH CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2125
Mailing Address - Country:US
Mailing Address - Phone:720-670-6243
Mailing Address - Fax:720-815-3343
Practice Address - Street 1:11169 E I25 FRONTAGE RD STE B
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-5276
Practice Address - Country:US
Practice Address - Phone:720-378-6670
Practice Address - Fax:303-557-9701
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist