Provider Demographics
NPI:1275924839
Name:YUCCA THERAPY SERVICES
Entity Type:Organization
Organization Name:YUCCA THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:575-496-0899
Mailing Address - Street 1:211 BLUE SKY LN
Mailing Address - Street 2:
Mailing Address - City:MESILLA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88047-9751
Mailing Address - Country:US
Mailing Address - Phone:575-496-0899
Mailing Address - Fax:575-377-8373
Practice Address - Street 1:211 BLUE SKY LN
Practice Address - Street 2:
Practice Address - City:MESILLA PARK
Practice Address - State:NM
Practice Address - Zip Code:88047-9751
Practice Address - Country:US
Practice Address - Phone:575-496-0899
Practice Address - Fax:575-377-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI35771041C0700X
NM1769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty