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General NPI Number Information
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NPI Number | 1821127515
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Entity Type | Individual
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Provider Name | MARY ANNE POWELL M. S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 2400 LEGACY CT
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City | SANTA FE
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State | NM
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Zip | 87507-4819
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Country | US
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Telephone | 505-501-8623
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Fax |
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Provider Business Mailing Address
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Address Line | 2269 CALLE CACIQUE
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City | SANTA FE
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State | NM
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Zip | 87505-4909
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Country | US
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Telephone | 505-690-3065
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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 | 3634
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License Number State | NM
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