Provider Demographics
NPI:1265627517
Name:IVINS, VICKI LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:IVINS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:TEKAMPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:390 S WESTERN AVE
Mailing Address - Street 2:UNIT # 207
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3449
Mailing Address - Country:US
Mailing Address - Phone:847-917-4621
Mailing Address - Fax:
Practice Address - Street 1:390 S WESTERN AVE
Practice Address - Street 2:UNIT # 207
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3449
Practice Address - Country:US
Practice Address - Phone:847-917-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist