1558099275 NPI number — VICTORIA PAIGE SCRUGGS M.S., CCC-SLP

Table of content: VICTORIA PAIGE SCRUGGS M.S., CCC-SLP (NPI 1558099275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558099275 NPI number — VICTORIA PAIGE SCRUGGS M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCRUGGS
Provider First Name:
VICTORIA
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558099275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 SANDHILL TOWNSHIP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLISVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39437-8418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-720-2896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 JEFFERSON ST STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39440-4355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-399-5539
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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