Healthcare Provider Details

I. General information

NPI: 1457452971
Provider Name (Legal Business Name): NEW MEXICO STATE UNIVERSITY SPEECH AND HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF UNIVERSITY AND JORDAN SPEECH BLDG. ROOM 158
LAS CRUCES NM
88003-8001
US

IV. Provider business mailing address

PO BOX 30001
LAS CRUCES NM
88003-8001
US

V. Phone/Fax

Practice location:
  • Phone: 505-646-3906
  • Fax: 505-646-3140
Mailing address:
  • Phone: 505-646-3906
  • Fax: 505-646-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number6545
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6545
License Number StateNM

VIII. Authorized Official

Name: DR. CONNIE E STOUT
Title or Position: CO-DIRECTOR OF CD PROGRAM
Credential: PH.D., CCC-SLP
Phone: 505-646-2364