Provider Demographics
NPI:1043044639
Name:SAINT VICTOR, SOANNE
Entity type:Individual
Prefix:
First Name:SOANNE
Middle Name:
Last Name:SAINT VICTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W ROBINHOOD DR STE 5
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5519
Mailing Address - Country:US
Mailing Address - Phone:209-451-4570
Mailing Address - Fax:
Practice Address - Street 1:1350 W ROBINHOOD DR STE 5
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5519
Practice Address - Country:US
Practice Address - Phone:209-451-4570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician