Individual
CAROLYN M KAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1241A CERRO GORDO RD, SANTA FE, NM 87501-6106
(307) 760-7079
(505) 467-2648
Mailing address
1241A CERRO GORDO RD, SANTA FE, NM 87501-6106
(307) 760-7079
(505) 467-2648
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
C-4984
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E7606
—
NM
Enumeration date
08/24/2011
Last updated
08/24/2011
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