Individual
MARY ELIZABETH WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7 COYOTE COURT, BOX 2290 RDT, NM 87557, TAOS, NM 87571
(575) 758-5763
Mailing address
PO BOX 2290, RANCHOS DE TAOS, NM 87557-2290
(575) 758-5763
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1057
NM
Other
Enumeration date
03/24/2009
Last updated
03/24/2009
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