Provider Demographics
NPI:1790227130
Name:DISCON, VICKI LYNNE (CSFA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNNE
Last Name:DISCON
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18100 WEST ROAD
Mailing Address - Street 2:APT. 910
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095
Mailing Address - Country:US
Mailing Address - Phone:570-977-9109
Mailing Address - Fax:
Practice Address - Street 1:18100 WEST RD
Practice Address - Street 2:APT. 910
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3768
Practice Address - Country:US
Practice Address - Phone:570-977-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA154792246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant