Provider Demographics
NPI:1427388586
Name:WAKEMAN, VICTORIA (BS, CD, LCCE)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:BS, CD, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2706
Mailing Address - Country:US
Mailing Address - Phone:605-691-9319
Mailing Address - Fax:
Practice Address - Street 1:303 17TH AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2706
Practice Address - Country:US
Practice Address - Phone:605-691-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD68796174H00000X
SD3300374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator