Provider Demographics
NPI:1134262512
Name:VALLEY DEVELOPMENT SERVICES INC
Entity type:Organization
Organization Name:VALLEY DEVELOPMENT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MADKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:909-908-1771
Mailing Address - Street 1:1681 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-8801
Mailing Address - Country:US
Mailing Address - Phone:877-284-8923
Mailing Address - Fax:877-284-8923
Practice Address - Street 1:4959 PALO VERDE ST STE 101C
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2358
Practice Address - Country:US
Practice Address - Phone:877-284-8923
Practice Address - Fax:877-284-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 130263164X00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9202009OtherINLAND EMPIRE HEALTH PLAN