Provider Demographics
NPI:1669592705
Name:VASILAKES, NANCY RAE (SLP, MA - CCC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:RAE
Last Name:VASILAKES
Suffix:
Gender:F
Credentials:SLP, MA - CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 S MARIPOSA LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2351
Mailing Address - Country:US
Mailing Address - Phone:406-248-8011
Mailing Address - Fax:
Practice Address - Street 1:1804 S MARIPOSA LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2351
Practice Address - Country:US
Practice Address - Phone:406-248-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT94235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist