Provider Demographics
NPI:1609284694
Name:APODACA, MARGARITA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:APODACA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 N JORNADA RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7214
Mailing Address - Country:US
Mailing Address - Phone:575-680-7531
Mailing Address - Fax:
Practice Address - Street 1:1600 S 107TH AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-2209
Practice Address - Country:US
Practice Address - Phone:623-478-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP8990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist