Victoria R. Wallace Bates, MS-CCC/SLP
Individual provider Active NPI Speech-Language Pathologist · Teton Village, WY
NPI 1376896092 · NPPES record last updated Oct 18, 2012
Key facts
- NPI
- 1376896092
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SP-126 (WY)
- Practice address
- 3850 N. Wilderness Dr.
Teton Village, WY 83025 - Phone
- (307) 733-8210
- NPI assigned
- Oct 18, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP-126 | WY | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP-126 | WY | Yes |
Addresses
Primary practice location
3850 N. Wilderness Dr.
Teton Village, WY 83025
Mailing address
P.O. Box 240
Wilson, WY 83014
Phone (307) 733-8210
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.