Individual
MRS. BROOKE FAULKNER VICKERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSP/CCC-SLP
Contact information
Practice address
115 CAROLINA OAKS DR, FOUNTAIN INN, SC 29644-8506
(803) 360-5228
Mailing address
115 CAROLINA OAKS DR, FOUNTAIN INN, SC 29644-8506
(803) 360-5228
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4372
SC
Other
Enumeration date
07/24/2009
Last updated
07/24/2009
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