Provider Demographics
NPI:1356115273
Name:EASTERN NEW MEXICO UNIVERSITY
Entity type:Organization
Organization Name:EASTERN NEW MEXICO UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-562-2156
Mailing Address - Street 1:1500 S AVENUE K # 3
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-7401
Mailing Address - Country:US
Mailing Address - Phone:575-562-2156
Mailing Address - Fax:575-562-2380
Practice Address - Street 1:1500 S AVENUE K # 3
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-7401
Practice Address - Country:US
Practice Address - Phone:575-562-2156
Practice Address - Fax:575-562-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty