Provider Demographics
NPI:1487860433
Name:GIBSON, VICTORIA CORNELUS (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CORNELUS
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 HELPING HANDS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-6890
Mailing Address - Country:US
Mailing Address - Phone:615-595-8938
Mailing Address - Fax:
Practice Address - Street 1:223 HELPING HANDS DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-6890
Practice Address - Country:US
Practice Address - Phone:615-595-8938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist