Individual
ELIZABETH BANNOWSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
901 MCCOY AVE, AZTEC, NM 87410-1727
(505) 334-6831
Mailing address
41 ROAD 3004, AZTEC, NM 87410-9504
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP7963
NM
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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