Provider Demographics
NPI:1417172289
Name:DORFMAN, VICKY A (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:A
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4397 RUSTLING WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-5462
Mailing Address - Country:US
Mailing Address - Phone:704-489-8056
Mailing Address - Fax:
Practice Address - Street 1:410 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-2840
Practice Address - Country:US
Practice Address - Phone:704-732-1745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5594235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist