Provider Demographics
NPI:1245757079
Name:ILACQUA, VALERIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:ILACQUA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 DESTINY DR STE 112
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2995
Mailing Address - Country:US
Mailing Address - Phone:916-415-0119
Mailing Address - Fax:916-415-0120
Practice Address - Street 1:6960 DESTINY DR STE 112
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2995
Practice Address - Country:US
Practice Address - Phone:916-415-0119
Practice Address - Fax:916-415-0120
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist