Individual
CHARLOTTE RUTH WANSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CF-SLP
Contact information
Practice address
700 FRANKLIN ST, SOCORRO, NM 87801-4666
(575) 835-0300
Mailing address
700 FRANKLIN ST, SOCORRO, NM 87801-4666
(575) 835-0300
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
C-5142
NM
Other
Enumeration date
07/20/2012
Last updated
08/27/2012
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