Provider Demographics
NPI:1689978694
Name:PROBASCO, VALERIE BLAIR (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:BLAIR
Last Name:PROBASCO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:13 WALNUT ST.
Mailing Address - City:SHILOH
Mailing Address - State:NJ
Mailing Address - Zip Code:08353-0134
Mailing Address - Country:US
Mailing Address - Phone:856-297-9509
Mailing Address - Fax:
Practice Address - Street 1:13 WALNUT ST.
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:NJ
Practice Address - Zip Code:08353-0134
Practice Address - Country:US
Practice Address - Phone:856-297-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00356200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist