Healthcare Provider Details

I. General information

NPI: 1932307147
Provider Name (Legal Business Name): ELLEN ESPINOSA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 9TH ST
ESTANCIA NM
87016
US

IV. Provider business mailing address

12708 PIRU BLVD SE
ALBUQUERQUE NM
87123-3825
US

V. Phone/Fax

Practice location:
  • Phone: 505-384-2000
  • Fax:
Mailing address:
  • Phone: 505-294-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number454
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: