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General NPI Number Information
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NPI Number | 1619426459
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Entity Type | Individual
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Provider Name | SUSAN ALLSHOUSE
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Gender | Female
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 3949 CORRALES RD STE 210
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City | CORRALES
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State | NM
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Zip | 87048-9347
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Country | US
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Telephone | 58-982-4745
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Fax |
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Provider Business Mailing Address
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Address Line | 9417 GUTIERREZ RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2511
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Country | US
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Telephone | 219-809-1304
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 23002728A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | AUD7275
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License Number State | NM
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