Provider Demographics
NPI:1831944198
Name:LAMB, VICTORIA L (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:L
Last Name:LAMB
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 1:444 T BIRD DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-9723
Mailing Address - Country:US
Mailing Address - Phone:920-602-2066
Mailing Address - Fax:
Practice Address - Street 1:444 T BIRD DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-9723
Practice Address - Country:US
Practice Address - Phone:920-602-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1825-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist