Provider Demographics
NPI:1477176758
Name:NEW MEXICO SPEECH AND SWALLOWING SERVICES, LLC
Entity Type:Organization
Organization Name:NEW MEXICO SPEECH AND SWALLOWING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDERICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-755-6677
Mailing Address - Street 1:400 E COLLEGE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-7570
Mailing Address - Country:US
Mailing Address - Phone:575-755-6677
Mailing Address - Fax:575-755-7277
Practice Address - Street 1:400 E COLLEGE BLVD STE E
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-7570
Practice Address - Country:US
Practice Address - Phone:575-755-6677
Practice Address - Fax:575-755-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty