Individual
AUDREY BAEZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, SLP-ASSISTANT
Contact information
Practice address
1500 S AVE K, STATION 3, SHROC, PORTALES, NM 88130
(915) 539-0053
Mailing address
1500 S AVE K, STATION 3, SHROC, PORTALES, NM 88130
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
36497
TX
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36497
STATE BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
TX
Enumeration date
09/08/2015
Last updated
11/03/2017
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