Organization
CREATIVE INTERACTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA PENICK MS, CCC, SLP (VICE PRESIDENT)
(505) 238-6106
Entity
Organization
Contact information
Practice address
7200 MONTGOMERY BLVD NE # 194, ALBUQUERQUE, NM 87109-1510
(505) 238-6106
Mailing address
7200 MONTGOMERY BLVD NE # 194, ALBUQUERQUE, NM 87109-1510
(505) 238-6106
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
MULITPLE LICENSES
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62725203
—
NM
Enumeration date
01/25/2007
Last updated
08/22/2020
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