Provider Demographics
NPI:1326111436
Name:CAMPOS, DEBRA SUE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:SUE
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HUERTA CT
Mailing Address - Street 2:ROSWELL
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201
Mailing Address - Country:US
Mailing Address - Phone:505-623-8171
Mailing Address - Fax:
Practice Address - Street 1:300 N CAMBRIDGE
Practice Address - Street 2:HAGERMAN SCHOOLS
Practice Address - City:HAGERMAN
Practice Address - State:NM
Practice Address - Zip Code:88232
Practice Address - Country:US
Practice Address - Phone:505-752-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM69736Medicaid