Provider Demographics
NPI:1427032978
Name:CORREA, JOSE ROBERTO (MS CCC-A)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ROBERTO
Last Name:CORREA
Suffix:
Gender:M
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 MAIN ST NE STE C
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6368
Mailing Address - Country:US
Mailing Address - Phone:505-916-5977
Mailing Address - Fax:505-916-5976
Practice Address - Street 1:2060 MAIN ST NE STE A
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6368
Practice Address - Country:US
Practice Address - Phone:505-247-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2840231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23028319Medicaid