Healthcare Provider Details

I. General information

NPI: 1508164922
Provider Name (Legal Business Name): M H VALE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 W 107TH LN
CROWN POINT IN
46307-2951
US

IV. Provider business mailing address

3805 W 107TH LN
CROWN POINT IN
46307-2951
US

V. Phone/Fax

Practice location:
  • Phone: 219-661-0867
  • Fax: 219-663-0299
Mailing address:
  • Phone: 219-661-0867
  • Fax: 219-663-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22002122A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number22002122A
License Number StateIN

VIII. Authorized Official

Name: MRS. MARLENE ADELE HERBST VALE
Title or Position: PRESIDENT, SPEECH PATHOLOGIST
Credential: M.A., L/CCC-SLP
Phone: 219-661-0867