Provider Demographics
NPI:1083453757
Name:DENNIS, VICTORIA ANNE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNE
Last Name:DENNIS
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 1:555 HIGHWAY 965 S APT 3
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9182
Mailing Address - Country:US
Mailing Address - Phone:319-621-9570
Mailing Address - Fax:
Practice Address - Street 1:409 B AVE
Practice Address - Street 2:
Practice Address - City:KALONA
Practice Address - State:IA
Practice Address - Zip Code:52247-7719
Practice Address - Country:US
Practice Address - Phone:641-777-2774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA125916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health