Provider Demographics
NPI:1548480080
Name:WILLIS, VICKY MICHELLE (HEARING INSTURMENT S)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:MICHELLE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:HEARING INSTURMENT S
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:M
Other - Last Name:MCCOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4121 SOUTH WATER TOWER PLACE, BELTONE HEARING
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864
Mailing Address - Country:US
Mailing Address - Phone:618-242-4901
Mailing Address - Fax:618-242-2458
Practice Address - Street 1:4121 WATERTOWER PLACE
Practice Address - Street 2:SUITE 3
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2347
Practice Address - Country:US
Practice Address - Phone:618-242-4901
Practice Address - Fax:618-242-2458
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2254237700000X
ILHIS2254237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist