Provider Demographics
NPI:1619207446
Name:BOLT, VICKI BEEKER
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:BEEKER
Last Name:BOLT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 N FANT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4700
Mailing Address - Country:US
Mailing Address - Phone:864-760-0203
Mailing Address - Fax:864-760-0203
Practice Address - Street 1:1530 N FANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4700
Practice Address - Country:US
Practice Address - Phone:864-760-0203
Practice Address - Fax:864-760-0203
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC458237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist