Provider Demographics
NPI:1407211998
Name:VALLERY, DAVID LARRY
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LARRY
Last Name:VALLERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 RIDERS CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2041
Mailing Address - Country:US
Mailing Address - Phone:608-783-7399
Mailing Address - Fax:608-783-7398
Practice Address - Street 1:202 1ST ST SE
Practice Address - Street 2:SUITE 209
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3946
Practice Address - Country:US
Practice Address - Phone:641-423-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078994237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist