=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851232474
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTORIA GLYNN GROSS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2026
-----------------------------------------------------
Last Update Date | 04/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3080 TEDDY DR
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70809-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-610-5740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17035 FOX RIDGE DR
-----------------------------------------------------
City | PRAIRIEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70769-4834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-610-5740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 14990
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------