Healthcare Provider Details

I. General information

NPI: 1316784937
Provider Name (Legal Business Name): MARISSA LEIGH VALDIVIA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N WILMOT RD
TUCSON AZ
85711-2601
US

IV. Provider business mailing address

355 N WILMOT RD
TUCSON AZ
85711-2601
US

V. Phone/Fax

Practice location:
  • Phone: 502-540-2001
  • Fax:
Mailing address:
  • Phone: 502-540-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP102349
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number122281
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP41286
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP17258
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: