Provider Demographics
NPI:1003029331
Name:WANK, VICTORIA DIANE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:DIANE
Last Name:WANK
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 1:7936 BELRIDGE RD
Mailing Address - Street 2:APT. K
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3620
Mailing Address - Country:US
Mailing Address - Phone:443-846-2001
Mailing Address - Fax:
Practice Address - Street 1:6501 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist