Individual
MYA COLASURDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
12200 LOMAS BLVD NE, MANZANO HS, ALBUQUERQUE, NM 87112-5804
(505) 559-2200
Mailing address
12200 LOMAS BLVD NE, MANZANO HS, ALBUQUERQUE, NM 87112-5804
(505) 559-2200
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
C 3847
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7478739
—
NM
Enumeration date
01/30/2007
Last updated
07/09/2007
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