Individual
LARA ELIZABETH WENTWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
3530 PAN AMERICAN FWY NE STE D, ALBUQUERQUE, NM 87107-4793
(505) 888-4469
Mailing address
7303 WILD OLIVE AVE NE, ALBUQUERQUE, NM 87113-2079
(505) 888-4469
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2218
NM
Other
Enumeration date
10/24/2006
Last updated
07/08/2007
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