Provider Demographics
NPI:1639343270
Name:VALLEY THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:VALLEY THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:208-324-2443
Mailing Address - Street 1:113 E AVENUE F
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-3132
Mailing Address - Country:US
Mailing Address - Phone:208-324-2443
Mailing Address - Fax:208-644-1167
Practice Address - Street 1:113 E AVENUE F
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-3132
Practice Address - Country:US
Practice Address - Phone:208-324-2443
Practice Address - Fax:208-644-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT9376OtherBLUE CROSS OF IDAHO
ID808102900Medicaid