Provider Demographics
NPI:1477215515
Name:REID, VICTORIA LA'COLE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LA'COLE
Last Name:REID
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 1:270 CONIFER WAY
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-7302
Mailing Address - Country:US
Mailing Address - Phone:828-506-5701
Mailing Address - Fax:980-701-0008
Practice Address - Street 1:270 CONIFER WAY
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-7302
Practice Address - Country:US
Practice Address - Phone:828-506-5701
Practice Address - Fax:980-701-0008
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist