Provider Demographics
NPI:1053440859
Name:FREEMAN, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:FREEMAN
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 1:5888 CLIFTMERE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-1848
Mailing Address - Country:US
Mailing Address - Phone:812-483-5821
Mailing Address - Fax:
Practice Address - Street 1:7955 MEADOW LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2841
Practice Address - Country:US
Practice Address - Phone:812-483-5821
Practice Address - Fax:812-490-6011
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IN751183373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist