Individual
MS. VICKIE SHEPPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
101 BROUGHAM AVE, MARION, AR 72364-2505
(870) 739-9982
Mailing address
707 ELDRIDGE AVE E, WYNNE, AR 72396-4032
(870) 208-8989
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP 1566
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12020540
ASHA ACCOUNT
AR
01
—
5X234
BLUE CROSS & BLUE SHIELD
AR
Enumeration date
01/23/2007
Last updated
07/09/2007
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