MEDICARE: VICKI CLEVERLEY - WARDELL MA 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
2	235Z00000X	Speech-Language Pathologist	SP-2902	NV

General Provider Information

NPI Number	:	1619534740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI CLEVERLEY - WARDELL MA CCC-SLP

Provider Business Mailing Address
First Line	:	5121 CHAMBLISS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2171
Country	:	US
Telephone Number	:	702-528-0981
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 CHAMBLISS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2171
Country	:	US
Telephone Number	:	702-528-0981
Fax Number	:

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

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	01/11/2023

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Directions to “ VICKI CLEVERLEY - WARDELL MA CCC-SLP” Practice Location

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