Healthcare Provider Details

I. General information

NPI: 1205478575
Provider Name (Legal Business Name): MICAH MAGEE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FARMINGTON HIGH SCHOOL 2200 N. SUNSET AVE
FARMINGTON NM
87401
US

IV. Provider business mailing address

3401 E 30TH ST SUITE A
FARMINGTON NM
87402
US

V. Phone/Fax

Practice location:
  • Phone: 505-324-0352
  • Fax:
Mailing address:
  • Phone: 505-599-8617
  • Fax: 855-290-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12080455
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: