Healthcare Provider Details

I. General information

NPI: 1205953890
Provider Name (Legal Business Name): PATHWAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 9TH ST
LAS VEGAS NM
87701-4037
US

IV. Provider business mailing address

5138 CASTLE ST
LAS VEGAS NM
87701-8949
US

V. Phone/Fax

Practice location:
  • Phone: 505-429-0805
  • Fax: 505-425-7196
Mailing address:
  • Phone: 505-426-7466
  • Fax: 505-425-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2311
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2311
License Number StateNM

VIII. Authorized Official

Name: MRS. RAYCHEL A HOSCH
Title or Position: OWNER
Credential: CCCSLP
Phone: 505-426-7466