MEDICARE: MS. VICTORIA M WEST

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	003143	CT

General Provider Information

NPI Number	:	1679829485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICTORIA M WEST

Provider Business Mailing Address
First Line	:	436 SPRING ST
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06451-5319
Country	:	US
Telephone Number	:	203-982-5454
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 SPRING ST
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06451-5319
Country	:	US
Telephone Number	:	203-982-5454
Fax Number	:

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

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	07/30/2012

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