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General NPI Number Information
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NPI Number | 1245711662
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Entity Type | Organization
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Legal Business Name | RISE SPEECH-LANGUAGE PATHOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1012 MARQUEZ PL STE 211
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City | SANTA FE
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State | NM
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Zip | 87505-1834
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Country | US
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Telephone | 505-302-0095
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Fax | 855-729-9346
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Provider Business Mailing Address
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Address Line | 15 CALLEJA MIRAMONTE
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City | LAMY
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State | NM
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Zip | 87540-9662
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Country | US
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Telephone | 505-919-8149
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Fax |
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Authorized Official
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Title or Position | SLP/OWNER
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Name | MICHELLE E GARCIA
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Credential | MS, CCC-SLP, BCS-CL
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Telephone | 505-302-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP4932
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License Number State | NM
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