Healthcare Provider Details

I. General information

NPI: 1508714932
Provider Name (Legal Business Name): MARLIE NEISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 9TH ST.
ESTANCIA NM
87016
US

IV. Provider business mailing address

PO BOX 68
ESTANCIA NM
87016-0068
US

V. Phone/Fax

Practice location:
  • Phone: 505-384-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2025-0396
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: