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General NPI Number Information
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NPI Number | 1801439328
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Entity Type | Individual
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Provider Name | KRISTEN GRIEGO M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 409 N CALIFORNIA ST
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City | SOCORRO
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State | NM
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Zip | 87801-4208
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Country | US
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Telephone | 505-907-1902
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Fax | 833-448-2997
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Provider Business Mailing Address
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Address Line | 119 MUSTANG DR
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City | SOCORRO
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State | NM
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Zip | 87801-4451
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Country | US
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Telephone | 575-518-8815
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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 | SLP7046
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | CF6772
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License Number State | NM
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