MEDICARE: NEW MEXICO STATE UNIVERSITY SPEECH AND HEARING CENTER

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	6545	NM
2	231H00000X	Audiologist	6545	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	:	1457452971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO STATE UNIVERSITY SPEECH AND HEARING CENTER

Provider Business Mailing Address
First Line	:	PO BOX 30001
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88003-8001
Country	:	US
Telephone Number	:	505-646-3906
Fax Number	:	505-646-3140

Provider Business Practice Location Address
First Line	:	CORNER OF UNIVERSITY AND JORDAN
Second Line	:	SPEECH BLDG. ROOM 158
City	:	LAS CRUCES
State	:	NM
Zip	:	88003-8001
Country	:	US
Telephone Number	:	505-646-3906
Fax Number	:	505-646-3140

Authorized Official
Title or Position	:	CO-DIRECTOR OF CD PROGRAM
Name	:	DR. CONNIE E STOUT
Credential	:	PH.D., CCC-SLP
Telephone Number	:	505-646-2364

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/11/2025

Similar Medicare Providers

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Practice Location Address:

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88003-8001

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1336200294 — NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER
Practice Location Address:

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1881756112 — DIANE JOY KRUIS MD
Practice Location Address:

CORNER OF STEWART AND BRELAND DR , NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER
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1871656579 — DR. WALTER TERRENCE MEYER MD
Practice Location Address:

NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER , MSC 3529 BOX 300001
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88003-8001

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1013050012 — MICHAEL J O'LAREY ATC
Practice Location Address:

MSC 3FAC NEW MEXICO STATE UNIVERSITY , P P BOX 30001
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1629285259 — MRS. CHARLOTTE H MASON M.S., CCC-SLP
Practice Location Address:

CORNER OF UNIVERSITY & JORDAN , SPEECH BUILDING ROOM 158
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Directions to “NEW MEXICO STATE UNIVERSITY SPEECH AND HEARING CENTER ” Practice Location

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