Provider Demographics
NPI:1740318336
Name:SANTA FE PUBLIC SCHOOLS
Entity type:Organization
Organization Name:SANTA FE PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:LOCKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:505-471-1974
Mailing Address - Street 1:2336 CAMINO DEL PRADO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4882
Mailing Address - Country:US
Mailing Address - Phone:505-471-1974
Mailing Address - Fax:
Practice Address - Street 1:610 ALTA VISTA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4149
Practice Address - Country:US
Practice Address - Phone:505-467-2502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ2761Medicaid