| NPI | 1881251916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISTIN L ROAN Speech & Language Pathologist 575-631-2897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2019-10-01 |