Provider Demographics
NPI:1225696511
Name:SANTIAGO DEL VALLE, MICHELLE LORRAINE (SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LORRAINE
Last Name:SANTIAGO DEL VALLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11891 OTSEGO LN
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-6402
Mailing Address - Country:US
Mailing Address - Phone:310-403-5182
Mailing Address - Fax:
Practice Address - Street 1:1323 W COLTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4554
Practice Address - Country:US
Practice Address - Phone:909-883-5069
Practice Address - Fax:909-883-5473
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP27623172V00000X, 235Z00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist