Provider Demographics
NPI:1568796514
Name:PANNETT, VICTORIA DEAN (MS, PLPC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:DEAN
Last Name:PANNETT
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9717 LANDMARK PARKWAY DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1628
Mailing Address - Country:US
Mailing Address - Phone:314-849-2120
Mailing Address - Fax:
Practice Address - Street 1:9717 LANDMARK PARKWAY DR
Practice Address - Street 2:SUITE 208
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1628
Practice Address - Country:US
Practice Address - Phone:314-849-2120
Practice Address - Fax:314-729-1953
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009026860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional