Provider Demographics
NPI:1033466438
Name:VALDIVIA, MILAGROS (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 100TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2203
Mailing Address - Country:US
Mailing Address - Phone:718-779-5068
Mailing Address - Fax:
Practice Address - Street 1:4020 100TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2203
Practice Address - Country:US
Practice Address - Phone:718-779-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist