Provider Demographics
NPI:1982146981
Name:CLOCK, VALERIA J
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:J
Last Name:CLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9810 HAMMOCKS BLVD
Mailing Address - Street 2:APT 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1512
Mailing Address - Country:US
Mailing Address - Phone:305-799-5802
Mailing Address - Fax:
Practice Address - Street 1:9810 HAMMOCKS BLVD
Practice Address - Street 2:APT 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1512
Practice Address - Country:US
Practice Address - Phone:305-799-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA18977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107437200Medicaid