Provider Demographics
NPI:1356411953
Name:VIGIL-RYAN, ALICIA (SPT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VIGIL-RYAN
Suffix:
Gender:F
Credentials:SPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:VIGIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3838 TUSCALOOSA WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1429
Mailing Address - Country:US
Mailing Address - Phone:928-607-4122
Mailing Address - Fax:
Practice Address - Street 1:3838 TUSCALOOSA WAY
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1429
Practice Address - Country:US
Practice Address - Phone:928-607-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7766767-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist