Provider Demographics
NPI:1386910461
Name:VALESANO, ALLIE JOY
Entity type:Individual
Prefix:MRS
First Name:ALLIE
Middle Name:JOY
Last Name:VALESANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:JOY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AAS HS, HS-BCP
Mailing Address - Street 1:12150 SW ALLEN BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14600 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5442
Practice Address - Country:US
Practice Address - Phone:503-684-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health