Provider Demographics
NPI:1295244275
Name:TALLEY, VICTORIA ELAINE KALEHUA (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELAINE KALEHUA
Last Name:TALLEY
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 SW LAFAYETTE PL
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-5200
Mailing Address - Country:US
Mailing Address - Phone:816-507-9989
Mailing Address - Fax:
Practice Address - Street 1:201 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-2537
Practice Address - Country:US
Practice Address - Phone:816-892-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017029770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist