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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
SLP

Contact information

Practice address
3609 MOON ST NE UNIT B, ALBUQUERQUE, NM 87111-3248
(505) 271-5422
Mailing address
3609 MOON ST NE UNIT B, ALBUQUERQUE, NM 87111-3248
(505) 271-5422

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
272
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
H 2294
NM
Enumeration date
01/29/2007
Last updated
10/09/2008
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