Organization
ICON INNOVATIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANA LYNN REILLY M.S., CCC-SLP (MANAGING MEMBER)
(505) 856-0284
Entity
Organization
Contact information
Practice address
9620 GIDDINGS AVE NE, ALBUQUERQUE, NM 87109-6413
(505) 856-0284
Mailing address
9620 GIDDINGS AVE NE, ALBUQUERQUE, NM 87109-6413
(505) 856-0284
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1818
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D0226
—
NM
Enumeration date
12/05/2006
Last updated
08/22/2020
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