Healthcare Provider Details

I. General information

NPI: 1548679756
Provider Name (Legal Business Name): MARISOL URIBE GONZALES SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 ANTHONY DRIVE
ANTHONY NM
88021
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 575-882-3401
  • Fax: 915-772-4633
Mailing address:
  • Phone: 515-526-6682
  • Fax: 575-523-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP6187
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: