Individual
MS. KIMBERLY A TRONCOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
1000 E AZTEC AVE, GALLUP, NM 87301-5509
(505) 721-1842
Mailing address
900 MILDA ST, GALLUP, NM 87301-7019
(505) 722-2575
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3464
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4138333
—
NM
Enumeration date
03/06/2007
Last updated
07/08/2007
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