Individual
MRS. MICHELLE RENEE BOURGUET-JIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CCC-SLP
Contact information
Practice address
I-40 WEST EXIT 114 TRAVEL RD 55, LAGUNA, NM 87026
(505) 552-9091
Mailing address
7420 TWISTED BRANCH ST NE, ALBUQUERQUE, NM 87113-0002
(505) 345-1619
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3427
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96551828
—
NM
Enumeration date
04/12/2007
Last updated
07/08/2007
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