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General NPI Number Information
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NPI Number | 1154885994
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Entity Type | Individual
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Provider Name | ELIZABETH LAUREN WINTER
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Gender | Female
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 27 LEYBA RD
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City | RANCHOS DE TAOS
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State | NM
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Zip | 87557-8701
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Country | US
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Telephone | 575-562-2156
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 47
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City | RANCHOS DE TAOS
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State | NM
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Zip | 87557-0047
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SAH-2024-0245
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License Number State | NM
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