Provider Demographics
NPI:1093599029
Name:PERRON, VICTORIA ROSE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:PERRON
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 1:2005 9TH ST E APT 210
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-3583
Mailing Address - Country:US
Mailing Address - Phone:651-442-0985
Mailing Address - Fax:
Practice Address - Street 1:800 WILSON AVE RM 330
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2746
Practice Address - Country:US
Practice Address - Phone:715-256-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YM0800X
WI7582-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health