Provider Demographics
NPI:1487860979
Name:CRUSE, VICKIE GILL (AUD)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:GILL
Last Name:CRUSE
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:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39568-0136
Mailing Address - Country:US
Mailing Address - Phone:228-762-1980
Mailing Address - Fax:228-696-8917
Practice Address - Street 1:2926 MARKET ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-5163
Practice Address - Country:US
Practice Address - Phone:228-762-1980
Practice Address - Fax:228-696-8917
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3139231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist