Provider Demographics
NPI:1619527785
Name:PEARSON, BARBARA JO (MAED)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JO
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88311-0650
Mailing Address - Country:US
Mailing Address - Phone:575-812-6000
Mailing Address - Fax:575-812-5999
Practice Address - Street 1:805 12TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6434
Practice Address - Country:US
Practice Address - Phone:575-812-6000
Practice Address - Fax:575-812-5999
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCF6797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCF6797OtherNM REGULATIONS AND LICENSING DEPARTMENT