Provider Demographics
NPI:1417602368
Name:GILMAN, VICTORIA GRACE (MT-BC, MMT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GRACE
Last Name:GILMAN
Suffix:
Gender:F
Credentials:MT-BC, MMT
Other - Prefix:
Other - First Name:VEE
Other - Middle Name:GRAE
Other - Last Name:GILMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT-BC
Mailing Address - Street 1:7024 57TH DR NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4106
Mailing Address - Country:US
Mailing Address - Phone:785-766-2751
Mailing Address - Fax:
Practice Address - Street 1:7607 TOTEM BEACH RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-6105
Practice Address - Country:US
Practice Address - Phone:785-766-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12134225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist