Individual
MARIA GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1700 PRINCETON DR SE, ALBUQUERQUE, NM 87106-3114
(505) 243-3161
(505) 243-3161
Mailing address
2123 SAINT CYR AVE SE, ALBUQUERQUE, NM 87106-5104
(505) 766-9773
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3040
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40886255
—
NM
Enumeration date
07/30/2006
Last updated
10/16/2008
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