Provider Demographics
NPI:1538205174
Name:ADAIR, VICTORIA LYNNE (SPEECH THERAPIST)
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:LYNNE
Last Name:ADAIR
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 4775
Mailing Address - Street 2:
Mailing Address - City:THEODOSIA
Mailing Address - State:MO
Mailing Address - Zip Code:65761-8413
Mailing Address - Country:US
Mailing Address - Phone:417-273-4274
Mailing Address - Fax:417-273-4171
Practice Address - Street 1:HC 4 BOX 4775
Practice Address - Street 2:
Practice Address - City:THEODOSIA
Practice Address - State:MO
Practice Address - Zip Code:65761-8413
Practice Address - Country:US
Practice Address - Phone:417-273-4274
Practice Address - Fax:417-273-4171
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 09-64235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist