Healthcare Provider Details

I. General information

NPI: 1366368961
Provider Name (Legal Business Name): MEADOW SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 SANDIA ST APT B
SANTA FE NM
87501-1320
US

IV. Provider business mailing address

903 W ALAMEDA ST # 803
SANTA FE NM
87501-1681
US

V. Phone/Fax

Practice location:
  • Phone: 505-570-5188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MIA MCMULLEN
Title or Position: OWNER
Credential: SLP
Phone: 505-570-5188