Provider Demographics
NPI:1548355084
Name:DELAIN, VALERIE AMELIE (PHD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:AMELIE
Last Name:DELAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W COLLEGE AVE STE 1125
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5744
Mailing Address - Country:US
Mailing Address - Phone:920-437-4490
Mailing Address - Fax:920-437-4492
Practice Address - Street 1:103 W COLLEGE AVE STE 1125
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5744
Practice Address - Country:US
Practice Address - Phone:920-437-4490
Practice Address - Fax:920-437-4492
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1530103T00000X, 103TC0700X, 103TF0200X, 261QM0850X, 261QM0855X
VA0810003479103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01-0579134OtherTAXPAYER ID # [TIN]
WI44284Medicare ID - Type Unspecified