Organization
GVS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
K I (OWNER)
(505) 804-5358
Entity
Organization
Contact information
Practice address
2901 JUAN TABO BLVD NE STE 100A, ALBUQUERQUE, NM 87112-1886
(505) 804-5358
(505) 501-7483
Mailing address
PO BOX 11175, ALBUQUERQUE, NM 87192-0175
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
11/05/2024
Last updated
07/21/2026
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