Healthcare Provider Details

I. General information

NPI: 1982833992
Provider Name (Legal Business Name): MICHELLE ELIZABETH GARCIA M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2009
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MARQUEZ PL SUITE 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:
Mailing address:
  • Phone: 505-302-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4932
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: