Healthcare Provider Details

I. General information

NPI: 1063355113
Provider Name (Legal Business Name): KRISTA VICTOR SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 MATHER BLVD
MATHER CA
95655-4116
US

IV. Provider business mailing address

4019 PARKSIDE CT
SACRAMENTO CA
95822-1624
US

V. Phone/Fax

Practice location:
  • Phone: 916-228-2500
  • Fax:
Mailing address:
  • Phone: 916-413-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number40772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: