1811217508 NPI number — MS. VICTORIA PENN MS CCC-SLP

Table of content: MS. VICTORIA PENN MS CCC-SLP (NPI 1811217508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811217508 NPI number — MS. VICTORIA PENN MS CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENN
Provider First Name:
VICTORIA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS 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:
1811217508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1290 SPERLING CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34103-2328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-580-8884
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1290 SPERLING CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34103-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-580-8884
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2010

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 , with the licence number:  SL003512L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA 10710 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SL003512L . This is a "BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SA 10710 . This is a "STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01101838 . This is a "AMERICAN SPEECH-LNAGUAGE-HEARING ASSOCIATION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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