Healthcare Provider Details

I. General information

NPI: 1730808247
Provider Name (Legal Business Name): VICTORIA HUFFMAN MA-SLP, CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA VASTINE VASTINE

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 TIGER DR
WAVERLY OH
45690-8704
US

IV. Provider business mailing address

1116 SARASUE AVE
PORTSMOUTH OH
45662-6444
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-2813
  • Fax:
Mailing address:
  • Phone: 740-381-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.15481
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: