Provider Demographics
NPI:1396834586
Name:GALLEGOS, SHERRY A (MA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:QUESTA
Mailing Address - State:NM
Mailing Address - Zip Code:87556-0631
Mailing Address - Country:US
Mailing Address - Phone:505-586-2116
Mailing Address - Fax:
Practice Address - Street 1:213 PASEO DEL CANON E
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6239
Practice Address - Country:US
Practice Address - Phone:505-758-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS6424Medicaid