Provider Demographics
NPI:1669513115
Name:DIGGS-MUNSON, C. SUZANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:C.
Middle Name:SUZANNE
Last Name:DIGGS-MUNSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E ALAMEDA ST
Mailing Address - Street 2:301 SOUTH MAIN STREET
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-6105
Mailing Address - Country:US
Mailing Address - Phone:505-624-3276
Mailing Address - Fax:
Practice Address - Street 1:400 WEST FIRST STREET
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:NM
Practice Address - Zip Code:88230-0159
Practice Address - Country:US
Practice Address - Phone:505-734-5434
Practice Address - Fax:505-734-5424
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM248417OtherNMDEPARTMENT OF ED.
NM09100218OtherASHA CERTIFIED MEMBER
NMG2756Medicaid