Provider Demographics
NPI:1134307184
Name:FITZMAURICE, SUE (SLP)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:FITZMAURICE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 UPTOWN BLVD NE STE 200W
Mailing Address - Street 2:CITY CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4278
Mailing Address - Country:US
Mailing Address - Phone:505-855-9958
Mailing Address - Fax:
Practice Address - Street 1:6400 UPTOWN BLVD NE STE 200W
Practice Address - Street 2:CITY CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4278
Practice Address - Country:US
Practice Address - Phone:505-855-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK0013Medicaid