Provider Demographics
NPI:1376694141
Name:CIRO, LINDA ANN (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:CIRO
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 W QUAY AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1826
Mailing Address - Country:US
Mailing Address - Phone:505-746-2777
Mailing Address - Fax:
Practice Address - Street 1:1106 W QUAY AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1826
Practice Address - Country:US
Practice Address - Phone:505-746-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM69742Medicaid