Provider Demographics
NPI:1518795335
Name:VEGA, VICTORIA ELAINE (MS CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELAINE
Last Name:VEGA
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2949
Mailing Address - Country:US
Mailing Address - Phone:708-269-1155
Mailing Address - Fax:
Practice Address - Street 1:808 8TH AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2949
Practice Address - Country:US
Practice Address - Phone:708-269-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist