Healthcare Provider Details

I. General information

NPI: 1497614408
Provider Name (Legal Business Name): KIARA HERZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12415 BRENTWOOD HILLS BLVD NE
ALBUQUERQUE NM
87112-3611
US

IV. Provider business mailing address

10609 PINO AVE NE
ALBUQUERQUE NM
87122-3440
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-6819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2025-0406
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: