Provider Demographics
NPI:1952328858
Name:LAURIE ROSS-BRENNAN & ASSOCIATES PA
Entity Type:Organization
Organization Name:LAURIE ROSS-BRENNAN & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS-BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:505-268-5933
Mailing Address - Street 1:4811E HARDWARE DR NE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2019
Mailing Address - Country:US
Mailing Address - Phone:505-268-5933
Mailing Address - Fax:505-268-0184
Practice Address - Street 1:4811E HARDWARE DR NE STE 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2019
Practice Address - Country:US
Practice Address - Phone:505-268-5933
Practice Address - Fax:505-268-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NML3146Medicaid
NMD0939Medicaid