Healthcare Provider Details

I. General information

NPI: 1093174559
Provider Name (Legal Business Name): IRASEMA CUELLAR SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 ANTHONY DR
ANTHONY NM
88021-9156
US

IV. Provider business mailing address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-3773
  • Fax:
Mailing address:
  • Phone: 575-526-6682
  • Fax: 575-523-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP6423
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: