Provider Demographics
NPI:1356850978
Name:CAMPOS, RACHEL CONSUELO (BA, ASL)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:CONSUELO
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:BA, ASL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 SANTA ROSA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3491
Mailing Address - Country:US
Mailing Address - Phone:505-699-4891
Mailing Address - Fax:
Practice Address - Street 1:2500 S MEADOWS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3601
Practice Address - Country:US
Practice Address - Phone:505-467-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3788552355S0801X
NMCF6386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant