Provider Demographics
NPI:1831326099
Name:AUSTIN, VICTORIA ELLEN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELLEN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MS 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:GATES CHILI CENTRAL SCHOOL DISTRICT
Mailing Address - Street 2:3 SPARTAN WAY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-247-5050
Mailing Address - Fax:585-247-1072
Practice Address - Street 1:GATES CHILI CENTRAL SCHOOL DISTRICT
Practice Address - Street 2:3 SPARTAN WAY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624
Practice Address - Country:US
Practice Address - Phone:585-247-5050
Practice Address - Fax:585-247-1072
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist