Provider Demographics
NPI:1225816358
Name:VICKERMAN-SMITH, DEANA
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:VICKERMAN-SMITH
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 1:305 S HUTCHINSON ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-2718
Mailing Address - Country:US
Mailing Address - Phone:815-943-6367
Mailing Address - Fax:
Practice Address - Street 1:305 S HUTCHINSON ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-2718
Practice Address - Country:US
Practice Address - Phone:815-943-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2622848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty