Provider Demographics
NPI:1275364036
Name:GUARDIPEE, VICTORIA I (MSW)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:GUARDIPEE
Suffix:I
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 BEAR DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-8775
Mailing Address - Country:US
Mailing Address - Phone:406-544-2928
Mailing Address - Fax:
Practice Address - Street 1:611 12TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2007
Practice Address - Country:US
Practice Address - Phone:206-324-9360
Practice Address - Fax:206-324-8910
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61577464261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)