Provider Demographics
NPI:1477601532
Name:WILLIAMS-GABALDON, MICHELLE KATHRYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:KATHRYN
Last Name:WILLIAMS-GABALDON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:BOSQUE FARMS
Mailing Address - State:NM
Mailing Address - Zip Code:87068-9332
Mailing Address - Country:US
Mailing Address - Phone:505-720-2765
Mailing Address - Fax:505-869-3011
Practice Address - Street 1:630 BARNETT RD
Practice Address - Street 2:
Practice Address - City:BOSQUE FARMS
Practice Address - State:NM
Practice Address - Zip Code:87068-9332
Practice Address - Country:US
Practice Address - Phone:505-720-2765
Practice Address - Fax:505-869-3011
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist