Provider Demographics
NPI:1588953673
Name:WILEY-GIRE, VICTORIA LYNN (SLP)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LYNN
Last Name:WILEY-GIRE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 PAR DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-8029
Mailing Address - Country:US
Mailing Address - Phone:619-461-9087
Mailing Address - Fax:619-461-9087
Practice Address - Street 1:3231 PAR DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-8029
Practice Address - Country:US
Practice Address - Phone:619-461-9087
Practice Address - Fax:619-461-9087
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 13206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA235Z00000XMedicare Oscar/Certification