Healthcare Provider Details

I. General information

NPI: 1770407314
Provider Name (Legal Business Name): LAUREN CERONIE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CAMINO SIERRA VISTA ANNEX
SANTA FE NM
87505
US

IV. Provider business mailing address

610 ALTA VISTA ST
SANTA FE NM
87505-4149
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-2504
  • Fax:
Mailing address:
  • Phone: 505-467-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2026-0067
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: