Provider Demographics
NPI:1649638354
Name:VALENZUELA, NEENAH (HIS)
Entity type:Individual
Prefix:MS
First Name:NEENAH
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43748 STEPHANIE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3393
Mailing Address - Country:US
Mailing Address - Phone:586-465-0034
Mailing Address - Fax:
Practice Address - Street 1:3660 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5213
Practice Address - Country:US
Practice Address - Phone:248-619-0680
Practice Address - Fax:248-619-0683
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004667237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist