Provider Demographics
NPI:1467958009
Name:LOVETT, VICTORIA ROSE (SLP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:LOVETT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W D STALVEY RD
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-4519
Mailing Address - Country:US
Mailing Address - Phone:229-560-6600
Mailing Address - Fax:888-841-9040
Practice Address - Street 1:112 IRVIN AVE SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2214
Practice Address - Country:US
Practice Address - Phone:229-560-6600
Practice Address - Fax:888-841-9040
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8429235Z00000X
FLSA16816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist