Provider Demographics
NPI:1457565210
Name:VANVALKENBURG, LOIS MARGARET (MS, MED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:MARGARET
Last Name:VANVALKENBURG
Suffix:
Gender:F
Credentials:MS, MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 E TOWNER ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-3242
Mailing Address - Country:US
Mailing Address - Phone:520-326-3844
Mailing Address - Fax:
Practice Address - Street 1:6630 E LIGHTNING DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85708-1043
Practice Address - Country:US
Practice Address - Phone:520-584-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ587339Medicaid