Provider Demographics
NPI:1922304260
Name:GEORGE, VICKI (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:
Last Name:GEORGE
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 1:4405 ATCHISON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6658
Mailing Address - Country:US
Mailing Address - Phone:479-756-6372
Mailing Address - Fax:
Practice Address - Street 1:1801 S 13TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-5850
Practice Address - Country:US
Practice Address - Phone:479-631-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist