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General NPI Number Information
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NPI Number | 1508164922
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Entity Type | Organization
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Legal Business Name | M H VALE, P.C.
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 3805 W 107TH LN
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City | CROWN POINT
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State | IN
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Zip | 46307-2951
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Country | US
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Telephone | 219-661-0867
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Fax | 219-663-0299
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Provider Business Mailing Address
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Address Line | 3805 W 107TH LN
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City | CROWN POINT
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State | IN
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Zip | 46307-2951
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Country | US
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Telephone | 219-661-0867
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Fax | 219-663-0299
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Authorized Official
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Title or Position | PRESIDENT, SPEECH PATHOLOGIST
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Name | MRS. MARLENE ADELE HERBST VALE
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Credential | M.A., L/CCC-SLP
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Telephone | 219-661-0867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 22002122A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22002122A
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License Number State | IN
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