Healthcare Provider Details

I. General information

NPI: 1568597474
Provider Name (Legal Business Name): VICKIE KAE HURD MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 3RD ST
JANESVILLE MN
56048-3017
US

IV. Provider business mailing address

675 BARNEY ST
OWATONNA MN
55060-3866
US

V. Phone/Fax

Practice location:
  • Phone: 507-234-6360
  • Fax: 507-234-5330
Mailing address:
  • Phone: 507-451-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number418752
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: