Organization
LISA SISNEROS BROW, SPEECH-LANGUAGE PATHOLOGIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA SISNEROS BROW M.S. CC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(505) 797-1952
Entity
Organization
Contact information
Practice address
11306 RICHFIELD AVE NE, ALBUQUERQUE, NM 87122-4188
(505) 797-1952
(505) 797-1952
Mailing address
11306 RICHFIELD AVE NE, ALBUQUERQUE, NM 87122-4188
(505) 797-1952
(505) 797-1952
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
277
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69325316
—
NM
01
—
D0997
MEDICAID WAIVER
NM
01
—
E114
BLUE CROSS BLUE SHIELD
NM
Enumeration date
01/03/2007
Last updated
08/22/2020
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