Healthcare Provider Details

I. General information

NPI: 1245711662
Provider Name (Legal Business Name): RISE SPEECH-LANGUAGE PATHOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MARQUEZ PL STE 211
SANTA FE NM
87505-1834
US

IV. Provider business mailing address

15 CALLEJA MIRAMONTE
LAMY NM
87540-9662
US

V. Phone/Fax

Practice location:
  • Phone: 505-302-0095
  • Fax: 855-729-9346
Mailing address:
  • Phone: 505-919-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP4932
License Number StateNM

VIII. Authorized Official

Name: MICHELLE E GARCIA
Title or Position: SLP/OWNER
Credential: MS, CCC-SLP, BCS-CL
Phone: 505-302-0095