Provider Demographics
NPI:1508065491
Name:SMITH, VICKI BERNARD (MS, CCC/A)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:BERNARD
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC/A
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:MARIE
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/A
Mailing Address - Street 1:14140 SOUTHWEST FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3842
Mailing Address - Country:US
Mailing Address - Phone:281-649-7000
Mailing Address - Fax:281-240-0030
Practice Address - Street 1:11914 ASTORIA BLVD STE 360
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6076
Practice Address - Country:US
Practice Address - Phone:281-484-3981
Practice Address - Fax:281-481-0182
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51282237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K5798Medicare PIN
TX8K5802Medicare PIN
TX8K5843Medicare PIN