Provider Demographics
NPI:1134346075
Name:BLEVINS, VICTORIA LENORE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LENORE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:BLEVINS
Other - Last Name:CHISHOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:347 OAKLAND ST SW
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3213
Mailing Address - Country:US
Mailing Address - Phone:571-225-1908
Mailing Address - Fax:276-783-7555
Practice Address - Street 1:347 OAKLAND ST SW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3213
Practice Address - Country:US
Practice Address - Phone:571-225-1908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00937235Z00000X
VA2202004980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004979907Medicaid
VA496647Medicare ID - Type Unspecified