Provider Demographics
NPI:1255440939
Name:HULET, VICKI NORTON (MS-CCCSLP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:NORTON
Last Name:HULET
Suffix:
Gender:F
Credentials:MS-CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-3118
Mailing Address - Country:US
Mailing Address - Phone:208-523-6199
Mailing Address - Fax:208-523-6002
Practice Address - Street 1:3446 MERLIN
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-523-3662
Practice Address - Fax:208-523-6002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDSLP-1461OtherIDAHO STATE LICENSE
ID6528800Medicaid
IDSPH54OtherBLUE CROSS
ID130065Medicare ID - Type Unspecified