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Organization
SOPHIE R. WAGNER, NM SPEECH-LANGUAGE PATHOLOGIST, LLC
Active
Organization
SOPHIE R. WAGNER, NM SPEECH-LANGUAGE PATHOLOGIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARYN WAGNER (OFFICE MANAGER)
(505) 980-5334
Entity
Organization
Contact information
Practice address
1503 CENTRAL AVE NW, UNIT 202, ALBUQUERQUE, NM 87104-1180
(505) 401-8204
(505) 232-3588
Mailing address
1503 CENTRAL AVE NW, UNIT 202, ALBUQUERQUE, NM 87104-1180
(505) 401-8204
(505) 232-3588
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
5431
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03272176005
CRS
NM
05
—
47631597
—
NM
01
—
81888228
MEDICAID, INDIVIDUAL PROVIDER ID, NOT BILLING PROVIDER ID
NM
Enumeration date
04/18/2014
Last updated
09/04/2014
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