Provider Demographics
NPI:1275251787
Name:BABAK, VIKTOR (SLP-ASSISTANT)
Entity Type:Individual
Prefix:
First Name:VIKTOR
Middle Name:
Last Name:BABAK
Suffix:
Gender:M
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7343 CANOPUS BOW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78252-2251
Mailing Address - Country:US
Mailing Address - Phone:646-691-0361
Mailing Address - Fax:
Practice Address - Street 1:13333 BLANCO RD STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7756
Practice Address - Country:US
Practice Address - Phone:210-479-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX427072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant