Healthcare Provider Details

I. General information

NPI: 1700207537
Provider Name (Legal Business Name): MEGAN THERESE WEBER ASL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N CALIFORNIA ST.
SOCORRO NM
87801
US

IV. Provider business mailing address

7450 CARSON TRL NW
ALBUQUERQUE NM
87120-4524
US

V. Phone/Fax

Practice location:
  • Phone: 575-838-0800
  • Fax: 575-838-3999
Mailing address:
  • Phone: 505-220-6409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number4845
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: