Healthcare Provider Details

I. General information

NPI: 1114377702
Provider Name (Legal Business Name): VALDEZ & SOTO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 SILVERNAIL RD
PEWAUKEE WI
53072-5402
US

IV. Provider business mailing address

2351 SILVERNAIL RD
PEWAUKEE WI
53072-5402
US

V. Phone/Fax

Practice location:
  • Phone: 262-260-9000
  • Fax: 262-260-9109
Mailing address:
  • Phone: 262-260-9000
  • Fax: 262-260-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BOBBI JO DURST
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 260-260-9000