Individual
MRS. TIFFANY MARIE HUIZENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
501 S ABILENE, PORTALES, NM 88130
(505) 359-3707
(505) 356-6682
Mailing address
501 S ABILENE, PORTALES, NM 88130
(505) 359-3707
(505) 356-6682
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
C3990
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39008371
—
NM
Enumeration date
11/28/2006
Last updated
07/08/2007
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