Provider Demographics
NPI:1649671892
Name:WINDBIEL, STEPHEN G
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:G
Last Name:WINDBIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3963
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-3963
Mailing Address - Country:US
Mailing Address - Phone:505-686-6617
Mailing Address - Fax:
Practice Address - Street 1:500 CARE LN
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-1552
Practice Address - Country:US
Practice Address - Phone:505-334-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4461235Z00000X
NMSLP4461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty