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General NPI Number Information
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NPI Number | 1124621958
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Entity Type | Individual
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Provider Name | CLARENCE GAIL VICTORIA SLP
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 2901 FALK RD
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City | VANCOUVER
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State | WA
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Zip | 98661-6392
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Country | US
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Telephone | 847-609-9903
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 484
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City | PORT ANGELES
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State | WA
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Zip | 98362-0074
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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