Individual
SUSAN KOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
2819 RICHMOND DR NE, ALBUQUERQUE, NM 87107-1918
(505) 883-3787
(505) 830-0106
Mailing address
3301 MONROE ST NE UNIT I98, ALBUQUERQUE, NM 87110-1873
(505) 980-4563
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
662
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10026768
LOVELACE HEALTH PLAN
NM
05
—
65824563
—
NM
01
—
QMYPR0072408
MOLINA HEALTH CARE
NM
Enumeration date
10/04/2006
Last updated
09/10/2020
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