Wallace, Vicki R
Wallace, Vicki R is an sole proprietor health care provider with primary practice located at 200 Gaston Ave , Fairmont WV 26554-2739. She recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as her primary health care specialty. Wallace, Vicki R can be contacted via phone (304) 624-6554.Contact Information
Primary practice address
200 Gaston Ave
Fairmont WV 26554-2739
Phone: (304) 624-6554
Fax: (304) 624-5223
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Audiologist | 231H00000X | A-0039 | West Virginia |
Profile Details
| NPI number | 1447420484 |
|---|---|
| LBN Legal business name | Wallace, Vicki R |
| Credentials | MS, CCC-A |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 5th, 2008 |
| Last updated | Mar 5th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447420484 | NPPES |
| West Virginia | MEDICAID | 0160325000 |
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