Basic Information
| Provider Information | |||||||||
| NPI: | 1871198739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERLEY | ||||||||
| FirstName: | NASTASSIA | ||||||||
| MiddleName: | TRISHANNE | ||||||||
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| Credential: | CF SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 COMPASS RD | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600268001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152322582 | ||||||||
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| Practice Location | |||||||||
| Address1: | 512 S 11TH ST | ||||||||
| Address2: | |||||||||
| City: | LAKE WALES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338534901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636768502 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2020 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SZ9961 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.