Provider Demographics
NPI:1245622356
Name:STAR COMMUNICATION DISORDERS
Entity type:Organization
Organization Name:STAR COMMUNICATION DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STARLIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:575-799-2270
Mailing Address - Street 1:101 BURCH PLACE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:575-799-2270
Mailing Address - Fax:
Practice Address - Street 1:101 BURCH PL
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-2920
Practice Address - Country:US
Practice Address - Phone:575-799-2270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3301305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33001OtherSTATE OF NM REGULATION & LICENSING DEP. SPEECH LANGUAGE PATHOLOGY