Healthcare Provider Details

I. General information

NPI: 1487480687
Provider Name (Legal Business Name): VICTORY SPEECH & LANGUAGE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 TURNPIKE AVE
PORTSMOUTH RI
02871-1422
US

IV. Provider business mailing address

234 TURNPIKE AVE
PORTSMOUTH RI
02871-1422
US

V. Phone/Fax

Practice location:
  • Phone: 860-798-5538
  • Fax:
Mailing address:
  • Phone: 860-798-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA PUZZO MENTY
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MS CCC-SLP
Phone: 860-798-5538