Provider Demographics
NPI:1376752568
Name:HALE, VICKIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:
Last Name:HALE
Suffix:
Gender:F
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 1:178 THOMPSON LN
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-3934
Mailing Address - Country:US
Mailing Address - Phone:423-869-5180
Mailing Address - Fax:
Practice Address - Street 1:178 THOMPSON LN
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-3934
Practice Address - Country:US
Practice Address - Phone:423-869-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist