Provider Demographics
NPI:1003594847
Name:CRUCE, VICTORIA K (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:K
Last Name:CRUCE
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 1:3400 OLD BAINBRIDGE RD APT 510
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-2680
Mailing Address - Country:US
Mailing Address - Phone:850-408-9978
Mailing Address - Fax:
Practice Address - Street 1:3400 OLD BAINBRIDGE RD APT 510
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-2680
Practice Address - Country:US
Practice Address - Phone:850-408-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist