Healthcare Provider Details

I. General information

NPI: 1649379033
Provider Name (Legal Business Name): WENDY JOAN GALLEGOS M.A. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 CORRALES RD STE 210
CORRALES NM
87048-9347
US

IV. Provider business mailing address

420 ASHLEY LN
CORRALES NM
87048-8940
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-2474
  • Fax: 505-899-8172
Mailing address:
  • Phone: 505-898-2474
  • Fax: 505-899-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberNM562
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: