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Individual

LISA ECKELKAMP

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, CCC-SLP, BCBA

Contact information

Practice address
5 MAES RD, B, CORRALES, NM 87048
(505) 249-8714
Mailing address
PO BOX 2674, CORRALES, NM 87048
(505) 249-8714

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11623536
NM
235Z00000X
Speech-Language Pathologist
3167
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
16939743
NM
Enumeration date
02/22/2007
Last updated
04/21/2017
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