Provider Demographics
NPI:1629285259
Name:MASON, CHARLOTTE H (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:H
Last Name:MASON
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 30001
Mailing Address - Street 2:MSC 3SPE
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003-8001
Mailing Address - Country:US
Mailing Address - Phone:505-646-7987
Mailing Address - Fax:505-646-3140
Practice Address - Street 1:CORNER OF UNIVERSITY & JORDAN
Practice Address - Street 2:SPEECH BUILDING ROOM 158
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003-8001
Practice Address - Country:US
Practice Address - Phone:505-646-7987
Practice Address - Fax:505-646-3140
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist