Individual
MRS. MICHELLE RENEE HARGRAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
4505 BALI CT NE, ALBUQUERQUE, NM 87111-2801
(505) 292-7104
(505) 296-2183
Mailing address
4505 BALI CT NE, ALBUQUERQUE, NM 87111-2801
(505) 292-7104
(505) 296-2183
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4367
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04481054
—
NM
Enumeration date
09/26/2007
Last updated
08/16/2010
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