| |
409 N California St, Socorro, NM 87801-4208 | |
(505) 907-1902 | |
(833) 448-2997 |
Full Name | |
---|---|
Type | Facility |
Speciality | Clinic/center - Hearing And Speech |
Location | 409 N California St, Socorro, New Mexico |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1134714348 | NPI | - | NPPES |
52071804 | Medicaid | NM | |
1184855181 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
235Z00000X | Speech-language Pathologist | (* (Not Available)) | Secondary |
261QH0700X | Clinic/center - Hearing And Speech | (* (Not Available)) | Primary |
Provider Name | Wilson Nice |
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Provider Type | Practitioner - Qualified Speech Language Pathologist |
Provider Identifiers | NPI Number: 1205135753 PECOS PAC ID: 8628473105 Enrollment ID: I20210820002535 |
Provider Name | Angela Mcmillan |
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Provider Type | Practitioner - Qualified Speech Language Pathologist |
Provider Identifiers | NPI Number: 1912344698 PECOS PAC ID: 7012381981 Enrollment ID: I20230315001923 |
Provider Name | Beverly Overton |
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Provider Type | Practitioner - Qualified Speech Language Pathologist |
Provider Identifiers | NPI Number: 1184855181 PECOS PAC ID: 3870959505 Enrollment ID: I20240329001465 |
Provider Name | Kristen Griego |
---|---|
Provider Type | Practitioner - Qualified Speech Language Pathologist |
Provider Identifiers | NPI Number: 1801439328 PECOS PAC ID: 5698210219 Enrollment ID: I20240726000620 |
Provider Name | Mary Elizabeth Bardin |
---|---|
Provider Type | Practitioner - Qualified Speech Language Pathologist |
Provider Identifiers | NPI Number: 1972035525 PECOS PAC ID: 4385050269 Enrollment ID: I20240930000301 |
Mailing Address | Practice Location Address |
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409 N California St, Socorro, NM 87801-4208 Ph: (505) 907-1902 | 409 N California St, Socorro, NM 87801-4208 Ph: (505) 907-1902 |