Provider Demographics
NPI:1548575038
Name:BOLD BEGINNINGS THERAPY
Entity Type:Organization
Organization Name:BOLD BEGINNINGS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROMERO-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:505-463-1874
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:TOME
Mailing Address - State:NM
Mailing Address - Zip Code:87060-0218
Mailing Address - Country:US
Mailing Address - Phone:505-463-1874
Mailing Address - Fax:
Practice Address - Street 1:75 ROMERO ROAD
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-463-1874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty