Provider Demographics
NPI:1376882134
Name:STOVALL, VALERIA (SLA)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:
Last Name:STOVALL
Suffix:
Gender:F
Credentials:SLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 ASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-6002
Mailing Address - Country:US
Mailing Address - Phone:662-537-7628
Mailing Address - Fax:662-335-2595
Practice Address - Street 1:1662 DEBRA DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7817
Practice Address - Country:US
Practice Address - Phone:662-537-7628
Practice Address - Fax:662-537-7887
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR192159721Medicaid