Provider Demographics
NPI:1285283028
Name:LORD, VICTORIA ROSE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:LORD
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 1:34 BURNHAM ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1221
Mailing Address - Country:US
Mailing Address - Phone:978-930-3921
Mailing Address - Fax:
Practice Address - Street 1:24 TRAPELO RD STE 2
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4460
Practice Address - Country:US
Practice Address - Phone:978-930-3921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76954-SP-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist