Healthcare Provider Details

I. General information

NPI: 1003338732
Provider Name (Legal Business Name): SILVER TONGUE SPEECH & VOICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 NORTHRIDGE DR STE C
FARMINGTON NM
87401
US

IV. Provider business mailing address

4771 SUNRISE CIR
FARMINGTON NM
87401-9299
US

V. Phone/Fax

Practice location:
  • Phone: 505-860-1485
  • Fax: 505-570-5462
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number5051290
License Number StateNM

VIII. Authorized Official

Name: BRENNA CAMILLE PRICE
Title or Position: SOLE MEMBER
Credential: M.S., CCC-SLP
Phone: 505-860-1485