| Doctor Name: | MS. BEVERLY ANNE VICKER |
| NPI Number: | 1659554970 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS CCCSLP |
| License Number: | 22001446A |
| Business Practice Address: | 768 E Sherwood Hills Dr Bloomington, IN - 474018178 |
| Business Phone Number: | 8123338145 |
| Business Fax Number: | 8123334008 |
| Mailing Address: | Po Box 8065, BLOOMINGTON |
| State: | IN |
| Postal Code: | 474078065 |
| Phone Number: | 8123338145 |
| Fax Number: | 8123334008 |
| NPI Enumeration Date: | 12/10/2007 |
| NPI Last Update Date: | 12/10/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 22001446A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |