Provider Demographics
NPI:1558885921
Name:TAYLOR, VICTORIA MOCK (AUD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MOCK
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:A
Other - Last Name:MOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:112 HAVEN DR STE 1
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2908
Mailing Address - Country:US
Mailing Address - Phone:343-793-6673
Mailing Address - Fax:334-792-0515
Practice Address - Street 1:112 HAVEN DR STE 1
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2908
Practice Address - Country:US
Practice Address - Phone:337-793-6673
Practice Address - Fax:334-792-0515
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2140231H00000X
AL1182A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist