Provider Demographics
NPI:1598155756
Name:CHOUDHURY, MOUMITA (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:MOUMITA
Middle Name:
Last Name:CHOUDHURY
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST
Mailing Address - Street 2:# 2A300
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-6073
Mailing Address - Country:US
Mailing Address - Phone:575-674-0593
Mailing Address - Fax:575-674-0599
Practice Address - Street 1:3600 ARROWHEAD DR.
Practice Address - Street 2:BLDG. 08
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5129
Practice Address - Country:US
Practice Address - Phone:575-674-0593
Practice Address - Fax:575-674-0599
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81138231H00000X
NM5668231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NML3211Medicaid