Provider Demographics
NPI:1477222776
Name:RIDGWAY, VICTORIA ROBYN
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROBYN
Last Name:RIDGWAY
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 1:4100 SWEETBRIER ST STE 109
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4579
Mailing Address - Country:US
Mailing Address - Phone:307-577-0722
Mailing Address - Fax:
Practice Address - Street 1:4100 SWEETBRIER ST STE 109
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-4579
Practice Address - Country:US
Practice Address - Phone:307-577-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator