Provider Demographics
NPI:1710450622
Name:RODGERS, VIKKI VAUGHAN
Entity Type:Individual
Prefix:
First Name:VIKKI
Middle Name:VAUGHAN
Last Name:RODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIKKI
Other - Middle Name:SHANE
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1530 LACIE DR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-5701
Mailing Address - Country:US
Mailing Address - Phone:205-915-8528
Mailing Address - Fax:
Practice Address - Street 1:6169 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-4056
Practice Address - Country:US
Practice Address - Phone:205-207-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist