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NPI Code Detail

MEDICARE: LINDA MACK BREWER PH.D.

MEDICARE: LINDA MACK BREWER PH.D.
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
1235Z00000XSpeech-Language Pathologist5875NM

General Provider Information

NPI Number : 1689045478
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA MACK BREWER PH.D.
Provider Business Mailing Address
First Line : 3300 N ATKINSON AVE APT 5
Second Line :
City : ROSWELL
State : NM
Zip : 88201-7816
Country : US
Telephone Number : 843-471-5566
Fax Number :
Provider Business Practice Location Address
First Line : 2218 W GRAND AVE
Second Line :
City : ARTESIA
State : NM
Zip : 88210-1624
Country : US
Telephone Number : 575-748-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2015
Last Update Date : 10/19/2015

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Directions to “ LINDA MACK BREWER PH.D.” Practice Location

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