Provider Demographics
NPI:1497179733
Name:BLACKWELL, VICTORIA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 SUFFOLK ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-1669
Mailing Address - Country:US
Mailing Address - Phone:201-888-6468
Mailing Address - Fax:
Practice Address - Street 1:1930 ANDREWS AVE S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-3004
Practice Address - Country:US
Practice Address - Phone:718-299-0306
Practice Address - Fax:718-299-0309
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist