Provider Demographics
NPI:1447505912
Name:LAVALLEE, LIA S (SLP)
Entity type:Individual
Prefix:MRS
First Name:LIA
Middle Name:S
Last Name:LAVALLEE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S LA POSADA CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5100
Mailing Address - Country:US
Mailing Address - Phone:520-648-2200
Mailing Address - Fax:
Practice Address - Street 1:700 S LA POSADA CIR
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5100
Practice Address - Country:US
Practice Address - Phone:520-648-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ169188Medicare PIN