Provider Demographics
NPI:1174346696
Name:BOSLEY, VICTORIA (SPEECH LANGUAGE PATH)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 TRACE FORK RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHLAND
Mailing Address - State:WV
Mailing Address - Zip Code:25506-0616
Mailing Address - Country:US
Mailing Address - Phone:304-360-1866
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 616
Practice Address - Street 2:
Practice Address - City:BRANCHLAND
Practice Address - State:WV
Practice Address - Zip Code:25506-0616
Practice Address - Country:US
Practice Address - Phone:304-360-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP0674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist