MEDICARE: VICTORIA LEE VACCARO CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146.012261	IL

General Provider Information

NPI Number	:	1306212501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA LEE VACCARO CCC-SLP

Provider Business Mailing Address
First Line	:	206 KNOLLWOOD ST
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-2113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 KNOLLWOOD ST
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-2113
Country	:	US
Telephone Number	:	847-924-9240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	11/09/2021

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