Healthcare Provider Details

I. General information

NPI: 1730715160
Provider Name (Legal Business Name): CARMEN ELENA PUENTES SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38300 WENDLING RD
MARCOLA OR
97454-9732
US

IV. Provider business mailing address

5516 S FORT APACHE RD
LAS VEGAS NV
89148-7678
US

V. Phone/Fax

Practice location:
  • Phone: 541-933-2817
  • Fax:
Mailing address:
  • Phone: 702-641-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number033722
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2639
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16987
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: