| Doctor Name: | KATIE VICKERY |
| NPI Number: | 1114358900 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | TLLP |
| License Number: | 6301015672 |
| Business Practice Address: | 1501 Krafft Rd Fort Gratiot, MI - 480593565 |
| Business Phone Number: | 8109855125 |
| Business Fax Number: | 8109855127 |
| Mailing Address: | 1501 Krafft Rd, FORT GRATIOT |
| State: | MI |
| Postal Code: | 480593565 |
| Phone Number: | 8109855125 |
| Fax Number: | 8109855127 |
| NPI Enumeration Date: | 12/05/2013 |
| NPI Last Update Date: | 12/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 6301015672 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |