Provider Demographics
NPI:1770775983
Name:WEDGE, VALERIE SUE (CTRS)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:SUE
Last Name:WEDGE
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:SUE
Other - Last Name:TUOMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32715 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3113
Mailing Address - Country:US
Mailing Address - Phone:248-427-1310
Mailing Address - Fax:
Practice Address - Street 1:32715 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3113
Practice Address - Country:US
Practice Address - Phone:248-427-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
52985225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
52985OtherNCTRC