Provider Demographics
NPI:1659599215
Name:HIGH DESERT LANGUAGE AND LEARNING, LLC
Entity Type:Organization
Organization Name:HIGH DESERT LANGUAGE AND LEARNING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEAMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SP
Authorized Official - Phone:505-722-2844
Mailing Address - Street 1:1010 MILDA ST
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-7022
Mailing Address - Country:US
Mailing Address - Phone:505-722-2844
Mailing Address - Fax:
Practice Address - Street 1:1010 MILDA ST
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-7022
Practice Address - Country:US
Practice Address - Phone:505-722-2844
Practice Address - Fax:505-863-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03050889000OtherCRS