Provider Demographics
NPI:1578068532
Name:NOLASCO, CAMILLE K (MS, SPEECH-LANGUAGE)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:K
Last Name:NOLASCO
Suffix:
Gender:F
Credentials:MS, SPEECH-LANGUAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 MANZANO ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5017
Mailing Address - Country:US
Mailing Address - Phone:970-471-5212
Mailing Address - Fax:
Practice Address - Street 1:1316 MANZANO ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5017
Practice Address - Country:US
Practice Address - Phone:970-471-5212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCF6445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist