Provider Demographics
NPI:1437685971
Name:DEASY, VICTORIA (AVT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:DEASY
Suffix:
Gender:F
Credentials:AVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 1/2 JUNO LN
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2813
Mailing Address - Country:US
Mailing Address - Phone:650-996-6575
Mailing Address - Fax:
Practice Address - Street 1:803 1/2 JUNO LN
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2813
Practice Address - Country:US
Practice Address - Phone:650-996-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC70712167235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC70712167OtherAG BELL ACADEMY FOR LISTENING AND SPOKEN LANGUAGE