Provider Demographics
NPI:1902145568
Name:VICTORIA, GRACE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 CORAL WAY
Mailing Address - Street 2:SUITE 602
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2631
Mailing Address - Country:US
Mailing Address - Phone:305-856-1999
Mailing Address - Fax:305-856-7600
Practice Address - Street 1:2153 CORAL WAY
Practice Address - Street 2:SUITE 602
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2631
Practice Address - Country:US
Practice Address - Phone:305-856-1999
Practice Address - Fax:305-856-7600
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6080235Z00000X
FLSA12747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist