Provider Demographics
NPI:1114379229
Name:STANDEFER, ERIN (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:STANDEFER
Suffix:
Gender:M
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:BURNWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:1225 LIBRA DR
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6125
Mailing Address - Country:US
Mailing Address - Phone:575-309-3434
Mailing Address - Fax:
Practice Address - Street 1:1225 LIBRA DR
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6125
Practice Address - Country:US
Practice Address - Phone:575-309-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist