Provider Demographics
NPI:1134644420
Name:BRICKENDEN, VICTORIA P (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:P
Last Name:BRICKENDEN
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 1:1460 ROCK SPRINGS CIR NE APT 1-1201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2238
Mailing Address - Country:US
Mailing Address - Phone:678-471-2701
Mailing Address - Fax:
Practice Address - Street 1:1192 FOSTER ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4329
Practice Address - Country:US
Practice Address - Phone:404-377-7436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist