Provider Demographics
NPI:1154543734
Name:BUNCH, VICTORIA CARDWELL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CARDWELL
Last Name:BUNCH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16495 15TH ST
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-6218
Mailing Address - Country:US
Mailing Address - Phone:757-373-4391
Mailing Address - Fax:
Practice Address - Street 1:9100 SAINT ANTHONYS RD
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3413
Practice Address - Country:US
Practice Address - Phone:540-775-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist