Provider Demographics
NPI:1962957209
Name:WANG, VICTORIA LYNN (SLPA)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LYNN
Last Name:WANG
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:LYNN
Other - Last Name:ARVIZU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:11286 WOOD RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7313
Mailing Address - Country:US
Mailing Address - Phone:818-634-1930
Mailing Address - Fax:
Practice Address - Street 1:12350 INDUSTRY WAY STE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4301
Practice Address - Country:US
Practice Address - Phone:907-301-4588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1127852355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant