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General NPI Number Information
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NPI Number | 1568653251
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Entity Type | Individual
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Provider Name | GRACE MARY FLICKER MS/SLP/ECE
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Gender | Female
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 8501 E YAVAPAI RD YAVAPAI CO. - ESA
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-8622
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Country | US
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Telephone | 928-771-3544
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Fax | 928-771-3549
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Provider Business Mailing Address
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Address Line | PO BOX 26326 YAVAPAI CO. - ESA
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86312-6326
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Country | US
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Telephone | 928-771-3544
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Fax | 928-771-3549
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | #SLPL0571
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License Number State | AZ
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