Individual
MRS. SUSAN GAYLE CARLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MACCCSIP A
Contact information
Practice address
1605 CAMINO RIO, FARMINGTON, NM 87401-8043
(505) 320-6325
(505) 325-4658
Mailing address
1605 CAMINO RIO, FARMINGTON, NM 87401-8043
(505) 320-6325
(505) 325-4658
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
052A
NM
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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