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Individual

KENNETH J VICTOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSY. D.

Contact information

Practice address
6541 SPECKER AVE BLDG 1830, FORT CARSON, CO 80913-4263
(791) 526-7155
Mailing address
6541 SPECKER AVE BLDG 1830, FORT CARSON, CO 80913-4263
(719) 526-7155

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041162A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200165440
IN
01
P00196681
RR
IN
01
P00453703
RR MEDICARE
IL
Enumeration date
01/04/2006
Last updated
11/28/2023
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