Provider Demographics
NPI:1508402249
Name:REID, VALERIE JEANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEANNE
Last Name:REID
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5247 BANCROFT AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2320
Mailing Address - Country:US
Mailing Address - Phone:314-479-1487
Mailing Address - Fax:
Practice Address - Street 1:5247 BANCROFT AVE APT 2E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2320
Practice Address - Country:US
Practice Address - Phone:314-479-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018039603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14177180OtherASHA