Provider Demographics
NPI:1609176395
Name:EDMUNDSON, VICTORIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:EDMUNDSON
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 1:27 WOODY LN
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3253
Mailing Address - Country:US
Mailing Address - Phone:917-751-5502
Mailing Address - Fax:
Practice Address - Street 1:430 LAKEVILLE ROAD
Practice Address - Street 2:LIJ
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:718-470-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist