Provider Demographics
NPI:1841090909
Name:WILLOUGHBY, VICTORIA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WILLOUGHBY
Suffix:
Gender:
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:HEISTERKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 26TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8230 HICKMAN RD STE A
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4303
Practice Address - Country:US
Practice Address - Phone:515-216-0161
Practice Address - Fax:515-400-1202
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist