Provider Demographics
NPI:1518019371
Name:ESPANOLA PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:ESPANOLA PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKERHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-753-2254
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:CHIMAYO
Mailing Address - State:NM
Mailing Address - Zip Code:87522-1005
Mailing Address - Country:US
Mailing Address - Phone:505-660-7822
Mailing Address - Fax:
Practice Address - Street 1:714 CALLE DON DIEGO
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3414
Practice Address - Country:US
Practice Address - Phone:505-753-2254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty