Healthcare Provider Details

I. General information

NPI: 1619426459
Provider Name (Legal Business Name): SUSAN ALLSHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 CORRALES RD STE 210
CORRALES NM
87048-9347
US

IV. Provider business mailing address

9417 GUTIERREZ RD NE
ALBUQUERQUE NM
87111-2511
US

V. Phone/Fax

Practice location:
  • Phone: 58-982-4745
  • Fax:
Mailing address:
  • Phone: 219-809-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD7275
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: