Provider Demographics
NPI:1508345570
Name:VALVERDE, ALEXISS DANIK
Entity Type:Individual
Prefix:
First Name:ALEXISS
Middle Name:DANIK
Last Name:VALVERDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:DANIK
Other - Last Name:VALVERDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 NORTH UPPER WACKER DRIVE
Mailing Address - Street 2:SUITE 1150
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8200 GUADALUPE TRL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1121
Practice Address - Country:US
Practice Address - Phone:505-898-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2022-09-20
Deactivation Date:2018-08-15
Deactivation Code:
Reactivation Date:2018-11-26
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NMCF7925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician