Provider Demographics
NPI:1558436048
Name:KESTERSON, VALLERY A (BC-HIS)
Entity Type:Individual
Prefix:
First Name:VALLERY
Middle Name:A
Last Name:KESTERSON
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 29TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3415
Mailing Address - Country:US
Mailing Address - Phone:541-967-0404
Mailing Address - Fax:541-967-6548
Practice Address - Street 1:950 29TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3415
Practice Address - Country:US
Practice Address - Phone:541-967-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHASP728324237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist