Individual
ILEANA DENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 S. AVE K, STATION 3, SHROC, PORTALES, NM 88130
(575) 562-2160
Mailing address
1500 S. AVE K STATION 3, SHROC, PORTALES, NM 88130
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
SPA3050
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/27/2016
Last updated
08/30/2017
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