Provider Demographics
NPI:1104609601
Name:PECHACEK, VICTORIA BAIRD
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:BAIRD
Last Name:PECHACEK
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 1:1068 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6121
Mailing Address - Country:US
Mailing Address - Phone:509-435-2936
Mailing Address - Fax:
Practice Address - Street 1:4 RABEL LN UNIT 34
Practice Address - Street 2:
Practice Address - City:GALLATIN GATEWAY
Practice Address - State:MT
Practice Address - Zip Code:59730-7002
Practice Address - Country:US
Practice Address - Phone:509-435-2936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health