Provider Demographics
NPI:1326114034
Name:HARLOW, IRENE ANNE (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:ANNE
Last Name:HARLOW
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:MISS
Other - First Name:IRENE
Other - Middle Name:ANNE
Other - Last Name:NEEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:GRADY
Mailing Address - State:NM
Mailing Address - Zip Code:88120
Mailing Address - Country:US
Mailing Address - Phone:505-357-2192
Mailing Address - Fax:505-357-2000
Practice Address - Street 1:100 FRANKLIN
Practice Address - Street 2:
Practice Address - City:GRADY
Practice Address - State:NM
Practice Address - Zip Code:88120
Practice Address - Country:US
Practice Address - Phone:505-357-2192
Practice Address - Fax:505-357-2000
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1481OtherNM DEPT OF ED SPEECH LANG
NM000L1825Medicaid