=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720121981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH MAIER SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12415 BRENTWOOD HILLS BLVD NE ONATE ES
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87112-3611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-291-6819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12415 BRENTWOOD HILLS BLVD NE ONATE ES
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87112-3611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-291-6819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1544
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
=====================================================
Legacy Identifiers
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | L 4735
-----------------------------------------------------
Identifier Type | MEDICAID
-----------------------------------------------------
Identifier State | NM
-----------------------------------------------------
Identifier Issuer |
-----------------------------------------------------
=====================================================
Proprietary Identifiers Ever Reported
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | L 4735
-----------------------------------------------------
Identifier Type | MEDICAID
-----------------------------------------------------
Identifier State | NM
-----------------------------------------------------
Identifier Issuer |
-----------------------------------------------------