Provider Demographics
NPI:1639546690
Name:VEDDER, LILY MARIAH ROCKWELL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:MARIAH ROCKWELL
Last Name:VEDDER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:MARIAH
Other - Last Name:ROCKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:4342 DEFIANCE PIKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:OH
Mailing Address - Zip Code:43466-9701
Mailing Address - Country:US
Mailing Address - Phone:740-238-1978
Mailing Address - Fax:
Practice Address - Street 1:4342 DEFIANCE PIKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:OH
Practice Address - Zip Code:43466-9701
Practice Address - Country:US
Practice Address - Phone:740-238-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007997235Z00000X
OHSP.12343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist