Provider Demographics
NPI:1598899577
Name:MIKOS, VICTORIA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANN
Last Name:MIKOS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 N HICKS RD
Mailing Address - Street 2:UNIT 201
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-2593
Mailing Address - Country:US
Mailing Address - Phone:847-494-3198
Mailing Address - Fax:
Practice Address - Street 1:1959 N HICKS RD
Practice Address - Street 2:UNIT 201
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-2593
Practice Address - Country:US
Practice Address - Phone:847-494-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001636409OtherBCBSIL