Provider Demographics
NPI:1568597474
Name:HURD, VICKIE KAE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:KAE
Last Name:HURD
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 1:675 BARNEY ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3866
Mailing Address - Country:US
Mailing Address - Phone:507-451-1887
Mailing Address - Fax:
Practice Address - Street 1:110 E 3RD ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56048-3017
Practice Address - Country:US
Practice Address - Phone:507-234-6360
Practice Address - Fax:507-234-5330
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN418752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist