Doctor Name: | MRS. VICTORIA R. WALLACE BATES |
NPI Number: | 1376896092 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS-CCC/SLP |
License Number: | SP-126 |
Business Practice Address: | 3850 N. Wilderness Dr. Teton Village, WY - 83025 |
Business Phone Number: | 3077338210 |
Business Fax Number: | |
Mailing Address: | P.o. Box 240, WILSON |
State: | WY |
Postal Code: | 83014 |
Phone Number: | 3077338210 |
Fax Number: | |
NPI Enumeration Date: | 10/18/2012 |
NPI Last Update Date: | 10/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP-126 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |