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General NPI Number Information
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NPI Number | 1336950260
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Entity Type | Individual
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Provider Name | HEATHER B VICKERY LSW
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 2014 VANDALIA ST
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City | COLLINSVILLE
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State | IL
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Zip | 62234-4848
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Country | US
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Telephone | 302-632-2059
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Fax |
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Provider Business Mailing Address
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Address Line | 618 QUAIL RUN
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City | O FALLON
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State | IL
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Zip | 62269-3142
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Country | US
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Telephone | 302-632-2059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.115703
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License Number State | IL
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