Provider Demographics
NPI:1922554005
Name:VETTER, ALICIA MARIE (MS ED, SLP-LIC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:VETTER
Suffix:
Gender:F
Credentials:MS ED, SLP-LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1319
Mailing Address - Country:US
Mailing Address - Phone:716-909-7420
Mailing Address - Fax:
Practice Address - Street 1:2733 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-7348
Practice Address - Country:US
Practice Address - Phone:716-631-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025979-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist