Provider Demographics
NPI:1225722002
Name:WALDREP, CALLIE
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:WALDREP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31781 BOCK ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1440
Mailing Address - Country:US
Mailing Address - Phone:734-219-3190
Mailing Address - Fax:734-939-0793
Practice Address - Street 1:31781 BOCK ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1440
Practice Address - Country:US
Practice Address - Phone:734-219-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist