Provider Demographics
NPI:1922403195
Name:DREW, VICTORIA LEIGH (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEIGH
Last Name:DREW
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3867
Mailing Address - Country:US
Mailing Address - Phone:719-582-9051
Mailing Address - Fax:
Practice Address - Street 1:6025 ERIN PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5400
Practice Address - Country:US
Practice Address - Phone:719-645-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-14-10431103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst