Provider Demographics
NPI:1437318268
Name:VICKERS, BRITTANY KIRSTEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:KIRSTEN
Last Name:VICKERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:KIRSTEN
Other - Last Name:PEDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:205 11TH ST E
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5445
Mailing Address - Country:US
Mailing Address - Phone:701-205-6318
Mailing Address - Fax:866-279-5137
Practice Address - Street 1:1135 2ND AVE W STE 207
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4175
Practice Address - Country:US
Practice Address - Phone:701-205-6318
Practice Address - Fax:866-279-5137
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455937Medicaid
ND2328OtherND STATE SLP LICENSE