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General NPI Number Information
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NPI Number | 1811217508
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Entity Type | Individual
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Provider Name | VICTORIA PENN MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 1290 SPERLING CT
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City | NAPLES
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State | FL
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Zip | 34103-2328
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Country | US
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Telephone | 239-580-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 1290 SPERLING CT
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City | NAPLES
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State | FL
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Zip | 34103-2328
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Country | US
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Telephone | 239-580-8884
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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 | SL003512L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA 10710
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License Number State | FL
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