Provider Demographics
NPI:1699253302
Name:MCGRADY, VICTORIA ANNETTE (MS)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNETTE
Last Name:MCGRADY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 FAIRMOUNT BOX 91
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67260-0091
Mailing Address - Country:US
Mailing Address - Phone:321-431-8878
Mailing Address - Fax:
Practice Address - Street 1:1845 FAIRMOUNT ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67260-9700
Practice Address - Country:US
Practice Address - Phone:316-978-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist