Provider Demographics
NPI:1700773686
Name:WYLD, VALLAREE ALYSE (AUD)
Entity type:Individual
Prefix:
First Name:VALLAREE
Middle Name:ALYSE
Last Name:WYLD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:VALLAREE
Other - Middle Name:ALYSE
Other - Last Name:ARCHAMABAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1050 KINGS HWY N STE 101
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1909
Mailing Address - Country:US
Mailing Address - Phone:856-438-5354
Mailing Address - Fax:856-435-5691
Practice Address - Street 1:1050 KINGS HWY N STE 101
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1909
Practice Address - Country:US
Practice Address - Phone:856-438-5354
Practice Address - Fax:856-435-5691
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00135700231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist