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General NPI Number Information
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NPI Number | 1528532801
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Entity Type | Individual
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Provider Name | DACIA RAQUEL PODRUCHNY I M.S. SLP
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Gender | Female
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Dates
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Enumeration Date | 01/19/2019
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 4950 MCNUTT RD
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City | SANTA TERESA
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State | NM
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Zip | 88008-9621
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Country | US
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Telephone | 575-882-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 2921 VALLE VIS
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City | LAS CRUCES
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State | NM
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Zip | 88011-4824
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Country | US
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Telephone | 915-433-6608
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SAH-2025-0293
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License Number State | NM
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