Provider Demographics
NPI:1326015439
Name:SEVERNS, VICTORIA MARIA FLEMING
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:MARIA FLEMING
Last Name:SEVERNS
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 1:2613 SYLVANGLEN ST
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2221
Mailing Address - Country:US
Mailing Address - Phone:817-447-0313
Mailing Address - Fax:
Practice Address - Street 1:4763 BARWICK DR
Practice Address - Street 2:OVERTON SPEECH AND LANGUAGE CENTER
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1531
Practice Address - Country:US
Practice Address - Phone:817-294-8408
Practice Address - Fax:817-294-8411
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15569OtherTX DEPT OF STATE HEALTH