Provider Demographics
NPI:1164988879
Name:WINTERROSE, VICTORIA MERRITT
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MERRITT
Last Name:WINTERROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MERRITT
Other - Last Name:SCHIMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:727 CLANCY DR
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:IL
Mailing Address - Zip Code:61320-9758
Mailing Address - Country:US
Mailing Address - Phone:815-503-2521
Mailing Address - Fax:
Practice Address - Street 1:710 PEORIA ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-3262
Practice Address - Country:US
Practice Address - Phone:815-780-0690
Practice Address - Fax:815-410-1937
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490253791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical