Provider Demographics
NPI:1780199158
Name:WEST SIDE SPEECH ACADEMY
Entity Type:Organization
Organization Name:WEST SIDE SPEECH ACADEMY
Other - Org Name:ROBIN H BILLMAIER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BILLMAIER
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCC, SLP
Authorized Official - Phone:505-259-8402
Mailing Address - Street 1:5208 RIVER RIDGE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3660
Mailing Address - Country:US
Mailing Address - Phone:505-259-8402
Mailing Address - Fax:505-433-3899
Practice Address - Street 1:5208 RIVER RIDGE AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3660
Practice Address - Country:US
Practice Address - Phone:505-259-8402
Practice Address - Fax:505-433-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========Medicaid