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General NPI Number Information
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NPI Number | 1396879060
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN NEW MEXICO SPEECH AND HEARING CLINIC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 1000 W 4TH ST
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City | ROSWELL
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State | NM
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Zip | 88201-3038
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Country | US
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Telephone | 575-623-8474
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Fax | 575-623-8220
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Provider Business Mailing Address
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Address Line | 1000 W 4TH ST
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City | ROSWELL
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State | NM
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Zip | 88201-3038
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Country | US
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Telephone | 575-623-8474
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Fax | 575-623-8220
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Authorized Official
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Title or Position | DOCTOR OF AUDIOLOGY
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Name | MRS. KATE HENGSTENBERG
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Credential | AUD
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Telephone | 575-623-8474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 3051
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License Number State | NM
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