Individual
MRS. VICTORIA R. WALLACE BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS-CCC/SLP
Contact information
Practice address
3850 N. WILDERNESS DR., TETON VILLAGE, WY 83025
(307) 733-8210
Mailing address
P.O. BOX 240, WILSON, WY 83014
(307) 733-8210
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-126
WY
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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