Individual
DR. MARLENE B SALAS-PROVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1405 INTERNATIONAL MALL, SPEECH BLDG. ROOM 158, LAS CRUCES, NM 88003-1279
(575) 646-3906
Mailing address
P.O. BOX 30001/MSC 3SPE, LAS CRUCES, NM 88003-8001
(575) 646-2364
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3836
NM
Other
Enumeration date
08/27/2010
Last updated
08/27/2010
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