Provider Demographics
NPI:1619534740
Name:CLEVERLEY - WARDELL, VICKI (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:CLEVERLEY - WARDELL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 CHAMBLISS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2171
Mailing Address - Country:US
Mailing Address - Phone:702-528-0981
Mailing Address - Fax:
Practice Address - Street 1:5121 CHAMBLISS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2171
Practice Address - Country:US
Practice Address - Phone:702-528-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NVSP-2902235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist