Provider Demographics
NPI:1023055357
Name:NILES, VICTORIA RAE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:RAE
Last Name:NILES
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 1:7010 DELORA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7412
Mailing Address - Country:US
Mailing Address - Phone:407-345-9223
Mailing Address - Fax:
Practice Address - Street 1:12424 RESEARCH PKWY
Practice Address - Street 2:SUITE 155
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3249
Practice Address - Country:US
Practice Address - Phone:407-249-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist