Provider Demographics
NPI:1093452781
Name:CORRALES VOICE & SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:CORRALES VOICE & SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SLP
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:505-226-6060
Mailing Address - Street 1:4686 CORRALES RD STE 1C
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8658
Mailing Address - Country:US
Mailing Address - Phone:505-226-6060
Mailing Address - Fax:505-226-9154
Practice Address - Street 1:4686 CORRALES RD STE 1
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-8610
Practice Address - Country:US
Practice Address - Phone:505-226-6060
Practice Address - Fax:888-496-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty