Provider Demographics
NPI:1265500094
Name:ADAMS, VICKIE LYNNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:LYNNE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:
Practice Address - Street 1:4896 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4352
Practice Address - Country:US
Practice Address - Phone:941-922-3351
Practice Address - Fax:941-927-5036
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY834231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600504700Medicaid
FLU8853ZMedicare UPIN