Provider Demographics
NPI:1972573020
Name:RIVES-VICKERY, CARIE DARLENE (MCD , CCC-A)
Entity Type:Individual
Prefix:
First Name:CARIE
Middle Name:DARLENE
Last Name:RIVES-VICKERY
Suffix:
Gender:F
Credentials:MCD , CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LIBERTY AVE
Mailing Address - Street 2:#522
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6850
Mailing Address - Country:US
Mailing Address - Phone:337-981-9422
Mailing Address - Fax:
Practice Address - Street 1:1270 ATTAKAPAS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6549
Practice Address - Country:US
Practice Address - Phone:337-942-1645
Practice Address - Fax:337-942-1659
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5372237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter