Provider Demographics
NPI:1750774378
Name:VICTORY COMMUNICATION SERVICES, LLC
Entity type:Organization
Organization Name:VICTORY COMMUNICATION SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:301-613-1986
Mailing Address - Street 1:10607 GREAT ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4220
Mailing Address - Country:US
Mailing Address - Phone:301-613-1986
Mailing Address - Fax:301-765-9558
Practice Address - Street 1:10607 GREAT ARBOR DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4220
Practice Address - Country:US
Practice Address - Phone:301-613-1986
Practice Address - Fax:301-765-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC000299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00172254OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOC. CERTIFICATION
DC056838900Medicaid
MD00685OtherBD OF EXAMINERS FOR AUDS, HADS, AND SLPS
DC000299OtherDC HEALTH & REGULATION LICENSING ADM BD OF AUD & SPEECH-LANG PATH