Healthcare Provider Details

I. General information

NPI: 1285361030
Provider Name (Legal Business Name): ERIN LEE WHITE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 CAMINA HERMOSA
FARMINGTON NM
87401-8137
US

IV. Provider business mailing address

4761 WESTWIND AVE
FARMINGTON NM
87401-9298
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8603
  • Fax:
Mailing address:
  • Phone: 505-860-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP4983
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: