Provider Demographics
NPI:1548767692
Name:RUSSELL, VALERIE MCCAY (SLP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:MCCAY
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 HIGHWAY 78 W
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3750
Mailing Address - Country:US
Mailing Address - Phone:205-295-5062
Mailing Address - Fax:844-269-8087
Practice Address - Street 1:710 HIGHWAY 78 W
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3750
Practice Address - Country:US
Practice Address - Phone:205-295-5062
Practice Address - Fax:844-269-8087
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist