Individual
KATHLEEN ELAINE VICKERS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1005 MAIN ST, FITCHBURG, MA 01420-3179
(160) 347-5519
Mailing address
1005 MAIN ST, FITCHBURG, MA 01420-3179
(160) 347-5519
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
S90889172
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2HC9-X05-FV36
—
MA
Enumeration date
06/11/2021
Last updated
06/11/2021
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