Provider Demographics
NPI:1689741480
Name:TAFOYA, SHIRLEY K (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:K
Last Name:TAFOYA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:K
Other - Last Name:PEREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2101 HAYES
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-9226
Mailing Address - Country:US
Mailing Address - Phone:505-749-1450
Mailing Address - Fax:
Practice Address - Street 1:501 S ABILENE AVE
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6380
Practice Address - Country:US
Practice Address - Phone:505-359-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist