Healthcare Provider Details

I. General information

NPI: 1295900207
Provider Name (Legal Business Name): SANTA FE THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CALLE MEDICO
SANTA FE NM
87505-4724
US

IV. Provider business mailing address

8 CALLE MEDICO
SANTA FE NM
87505-4724
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-8777
  • Fax: 505-424-9777
Mailing address:
  • Phone: 505-424-8777
  • Fax: 505-424-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number443
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number457
License Number StateNM

VIII. Authorized Official

Name: MRS. MELISSA WILSON
Title or Position: OWNER/DIRECTOR
Credential: SLP
Phone: 505-424-8777