Individual
JANET VALLESE BROOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1565 BOSQUECITO ROAD, SOCORRO, NM 87801
(505) 835-2118
(505) 835-2118
Mailing address
PO BOX 58, 1565 BOSQUECITO ROAD, SOCORRO, NM 87801, LEMITAR, NM 87823-0058
(505) 835-2118
(505) 835-2118
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
410
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000D1615
—
NM
01
—
01025724
ASHA CERTIFIED
NM
01
—
02083282006
CRS ID NUMBER
NM
01
—
410
SLP BOARD LICENSE
NM
05
—
78902525
—
NM
Enumeration date
08/01/2006
Last updated
07/09/2007
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