Healthcare Provider Details

I. General information

NPI: 1811266968
Provider Name (Legal Business Name): MS. LEDEIDRE S GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 S MAIN ST STE A
LAS CRUCES NM
88005-3113
US

IV. Provider business mailing address

4500 SATELLITE BLVD STE 2290
DULUTH GA
30096-5037
US

V. Phone/Fax

Practice location:
  • Phone: 575-386-4184
  • Fax: 575-526-1568
Mailing address:
  • Phone: 800-381-2195
  • Fax: 888-381-0822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA000234
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: