Provider Demographics
NPI:1427195866
Name:KING, VICKI DENISE (MCD, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:DENISE
Last Name:KING
Suffix:
Gender:F
Credentials:MCD, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-6354
Mailing Address - Country:US
Mailing Address - Phone:864-430-9922
Mailing Address - Fax:
Practice Address - Street 1:241 POPLAR LN
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-6354
Practice Address - Country:US
Practice Address - Phone:864-430-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC191915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist