Provider Demographics
NPI:1881091445
Name:MYER, VICKI (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:MYER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 GOODMAN LN
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1107
Mailing Address - Country:US
Mailing Address - Phone:816-806-3581
Mailing Address - Fax:
Practice Address - Street 1:5110 GOODMAN LN
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-1107
Practice Address - Country:US
Practice Address - Phone:816-806-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist