Organization
CENTRAL REGION EDUCATIONAL COOPERATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKY FUESSEL (SLP SUPERVISOR)
(505) 889-3412
Entity
Organization
Contact information
Practice address
5323 MENAUL BLVD. NE, ALBUQUERQUE, NM 87110
(505) 889-3412
(505) 889-3422
Mailing address
5323 MENAUL BLVD. NE, ALBUQUERQUE, NM 87110
(505) 889-3412
(505) 889-3422
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5290
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194881565
—
NM
Enumeration date
03/27/2013
Last updated
03/27/2013
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