MEDICARE: VIKKI LEGGETTT MS/CCC-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	S2917	MS

General Provider Information

NPI Number	:	1295288934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIKKI LEGGETTT MS/CCC-SLP

Provider Business Mailing Address
First Line	:	22 FLEETWOOD PL
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5112
Country	:	US
Telephone Number	:	228-365-6713
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 FLEETWOOD PL
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5112
Country	:	US
Telephone Number	:	228-365-6713
Fax Number	:

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

Provider Enumeration Date	:	07/29/2016
Last Update Date	:	07/29/2016

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