Provider Demographics
NPI:1093091548
Name:HOWARD, AMBER ROSE (SLP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 MONTGOMERY BLVD NE
Mailing Address - Street 2:ELDORADO HS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2602
Mailing Address - Country:US
Mailing Address - Phone:505-296-4871
Mailing Address - Fax:
Practice Address - Street 1:11300 MONTGOMERY BLVD NE
Practice Address - Street 2:ELDORADO HS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2602
Practice Address - Country:US
Practice Address - Phone:505-296-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC 5005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ASSIGNEDMedicaid