Provider Demographics
NPI:1386629186
Name:BUGTONG, VICTORIA ANN (AUD, CSP/A, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ANN
Last Name:BUGTONG
Suffix:
Gender:F
Credentials:AUD, CSP/A, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 HULL DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-4131
Mailing Address - Country:US
Mailing Address - Phone:301-806-3736
Mailing Address - Fax:
Practice Address - Street 1:2480 LLEWELLYN AVE
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-7081
Practice Address - Country:US
Practice Address - Phone:301-677-8140
Practice Address - Fax:301-677-8077
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI148237600000X
HI101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter