Provider Demographics
NPI:1598768657
Name:CLIFFORD, CAROL L (AUD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 CORRALES ROAD
Mailing Address - Street 2:SUITE I
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114
Mailing Address - Country:US
Mailing Address - Phone:505-890-0003
Mailing Address - Fax:505-890-3330
Practice Address - Street 1:10700 CORRALES ROAD
Practice Address - Street 2:SUITE I
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-890-0003
Practice Address - Fax:505-890-3330
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1124231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00K42WOtherBCBS
NM000F3266Medicaid
NMNM00184OtherMEDICARE PTAN
NMNM00K42WOtherBCBS