MEDICARE: ABC PEDIATRIC THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4246	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437473089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	3308 OASIS SPRINGS RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-2579
Country	:	US
Telephone Number	:	505-980-3051
Fax Number	:	505-892-7359

Provider Business Practice Location Address
First Line	:	3308 OASIS SPRINGS RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-2579
Country	:	US
Telephone Number	:	505-891-2590
Fax Number	:	505-892-7359

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	MS. VICTORIA MARGARET HERRERA
Credential	:	M.S., CCC-SLP
Telephone Number	:	505-891-2590

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	04/29/2019

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Directions to “ABC PEDIATRIC THERAPY ” Practice Location

Language	Start Address	Practice Location

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