Healthcare Provider Details

I. General information

NPI: 1477468734
Provider Name (Legal Business Name): VALERIE LYNN WADA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIE LYNN GREGORASH SLP

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 HILL RD
NOVATO CA
94947-4063
US

IV. Provider business mailing address

1201 VALLEJO AVE APT 2
NOVATO CA
94945-2333
US

V. Phone/Fax

Practice location:
  • Phone: 415-897-6161
  • Fax:
Mailing address:
  • Phone: 818-284-3342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: