Provider Demographics
NPI:1043531569
Name:MONTALVO, VICKIE LEE (MS CCC-SLP / L)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:LEE
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:MS CCC-SLP / L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 COUNTY ROAD 3
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-3217
Mailing Address - Country:US
Mailing Address - Phone:607-222-6966
Mailing Address - Fax:
Practice Address - Street 1:2004 COUNTY ROAD 3
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830-3217
Practice Address - Country:US
Practice Address - Phone:607-222-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016987-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist