MEDICARE: VICKI VOSS SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP-1319	ID

General Provider Information

NPI Number	:	1265661003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI VOSS SLP

Provider Business Mailing Address
First Line	:	P.O. BOX 855
Second Line	:
City	:	IDAHO CITY
State	:	ID
Zip	:	83631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 BRASSEY CIR
Second Line	:
City	:	IDAHO CITY
State	:	ID
Zip	:	83631-4103
Country	:	US
Telephone Number	:	298-392-9585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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Directions to “ VICKI VOSS SLP” Practice Location

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