Provider Demographics
NPI:1932381738
Name:ROANHORSE, VALERIE ANN
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:ANN
Last Name:ROANHORSE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VALERIA
Other - Middle Name:ANN
Other - Last Name:ROANHORSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505
Mailing Address - Country:US
Mailing Address - Phone:928-755-6506
Mailing Address - Fax:
Practice Address - Street 1:294 WEST CARLOS
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025
Practice Address - Country:US
Practice Address - Phone:928-755-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ815970Medicaid