Organization
INNOVATIVE SPEECH THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STACIE GRAY M.S., CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(505) 417-3045
Entity
Organization
Contact information
Practice address
5801 LOWELL ST NE, 26B, ALBUQUERQUE, NM 87111-5942
(505) 417-3045
(505) 294-8989
Mailing address
5801 LOWELL ST NE, 26B, ALBUQUERQUE, NM 87111-5942
(505) 417-3045
(505) 294-8989
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90079744
—
NM
Enumeration date
01/13/2010
Last updated
01/13/2010
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