Individual
GWEN PATRIARCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1600 SUTTER PLACE, STUDENT SUPPORT CENTER, CLOVIS, NM 88012-9000
(575) 769-4490
(575) 769-4533
Mailing address
PO BOX 19000, CLOVIS, NM 88102-9000
(575) 769-4490
(575) 769-4533
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
655
NM
235Z00000X
Speech-Language Pathologist
655
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
K 3216
—
NM
Enumeration date
03/13/2007
Last updated
11/01/2017
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