Provider Demographics
NPI:1083383764
Name:MOGOL, VICTORIA A
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:MOGOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-3023
Mailing Address - Country:US
Mailing Address - Phone:603-692-4411
Mailing Address - Fax:
Practice Address - Street 1:511 FIRST NEW HAMPSHIRE TPKE
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:NH
Practice Address - Zip Code:03261-3411
Practice Address - Country:US
Practice Address - Phone:603-942-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2320235Z00000X
NH02102355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant