Provider Demographics
NPI:1841338472
Name:PULLINS, VICKIE HINZMAN
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:HINZMAN
Last Name:PULLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 WETHERSFIELD XING
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8719
Mailing Address - Country:US
Mailing Address - Phone:304-757-4510
Mailing Address - Fax:304-757-4511
Practice Address - Street 1:1019 WETHERSFIELD XING
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8719
Practice Address - Country:US
Practice Address - Phone:304-757-4510
Practice Address - Fax:304-757-4511
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0152347000Medicaid