| Doctor Name: | MRS. VALERIE WIETEN |
| NPI Number: | 1619370491 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | L529610 |
| Business Practice Address: | 2505 Ardmore St Se Grand Rapids, MI - 495064924 |
| Business Phone Number: | 6168229051 |
| Business Fax Number: | 6165591056 |
| Mailing Address: | 1020 Brownwood Ave Nw, GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495043651 |
| Phone Number: | 6168229051 |
| Fax Number: | 6165591056 |
| NPI Enumeration Date: | 10/07/2014 |
| NPI Last Update Date: | 04/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | L529610 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |