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General NPI Number Information
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NPI Number | 1568760445
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Entity Type | Organization
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Legal Business Name | REGIONAL EDUCATION CENTER
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 1500 S AVENUE K STATION #9
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City | PORTALES
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State | NM
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Zip | 88130-7400
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Country | US
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Telephone | 575-562-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S AVENUE K STATION #9
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City | PORTALES
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State | NM
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Zip | 88130-7400
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Country | US
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Telephone | 575-562-4455
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. PATTI HARRELSON
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Credential |
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Telephone | 575-562-4455
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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 | 1826
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License Number State | NM
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