Individual
THOMAS MATTHEW TICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
500 LASER DR NE, RIO RANCHO, NM 87124-4517
(505) 896-0667
Mailing address
5732 RIO OSO DR NE, RIO RANCHO, NM 87144-4703
(505) 892-3077
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1623
NM
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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