Provider Demographics
NPI:1255457339
Name:SPEAKER, ELIZABETH SUSAN (LCPP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:SPEAKER
Suffix:
Gender:F
Credentials:LCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 WASHINGTON PL NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1720
Mailing Address - Country:US
Mailing Address - Phone:505-507-4408
Mailing Address - Fax:
Practice Address - Street 1:8417 WASHINGTON PL NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1720
Practice Address - Country:US
Practice Address - Phone:505-507-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0102551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM600744Medicaid
NM35473011Medicaid
NM58138251Medicaid