MEDICARE: VALERIE MASON DILLARD MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1568943330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE MASON DILLARD MS, CCC-SLP

Provider Business Mailing Address
First Line	:	5322 WILLOW WALK RD
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-1930
Country	:	US
Telephone Number	:	313-804-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	5322 WILLOW WALK RD
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-1930
Country	:	US
Telephone Number	:	313-804-6611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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Directions to “ VALERIE MASON DILLARD MS, CCC-SLP” Practice Location

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