Healthcare Provider Details

I. General information

NPI: 1013457365
Provider Name (Legal Business Name): COURTNEY GARCIA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400A E 20TH ST
FARMINGTON NM
87401-9024
US

IV. Provider business mailing address

1400A E 20TH ST
FARMINGTON NM
87401-9024
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8762
  • Fax: 855-290-2205
Mailing address:
  • Phone: 505-599-8762
  • Fax: 855-290-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6117
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: