Healthcare Provider Details

I. General information

NPI: 1033210448
Provider Name (Legal Business Name): BERNALILLO PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N CAMINO DEL PUEBLO
BERNALILLO NM
87004-6146
US

IV. Provider business mailing address

224 N CAMINO DEL PUEBLO
BERNALILLO NM
87004-6146
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-5727
  • Fax: 505-867-7891
Mailing address:
  • Phone: 505-404-5727
  • Fax: 505-867-7891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1556
License Number StateNM

VIII. Authorized Official

Name: GAIL NIEMANN
Title or Position: SPEECH AND LANGUAGE PATHOLOGIST
Credential:
Phone: 505-404-5727