Provider Demographics
NPI:1053053090
Name:THOMPSON, VICTORIA TERRILL
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:TERRILL
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N WEST AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-1314
Mailing Address - Country:US
Mailing Address - Phone:605-403-0933
Mailing Address - Fax:
Practice Address - Street 1:1000 N WEST AVE STE 210
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-1314
Practice Address - Country:US
Practice Address - Phone:605-403-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096931235Z00000X
SD1047-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist