Provider Demographics
NPI:1780032821
Name:VICTORY SPEECH THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:VICTORY SPEECH THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:YALONDA
Authorized Official - Middle Name:SENIECE
Authorized Official - Last Name:JOHNSON PACKER
Authorized Official - Suffix:
Authorized Official - Credentials:M ED CCC-SLP
Authorized Official - Phone:910-305-6469
Mailing Address - Street 1:1533 ELLIS RD.
Mailing Address - Street 2:APT J208
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703
Mailing Address - Country:US
Mailing Address - Phone:910-305-6469
Mailing Address - Fax:
Practice Address - Street 1:1533 ELLIS RD.
Practice Address - Street 2:APT J208
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703
Practice Address - Country:US
Practice Address - Phone:910-305-6469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty