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General NPI Number Information
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NPI Number | 1881468130
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Entity Type | Organization
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Legal Business Name | ZIA SPEECH AND SWALLOW LLC
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 1023 W 15TH ST
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City | PORTALES
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State | NM
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Zip | 88130-6680
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Country | US
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Telephone | 208-539-8711
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 JEFFERSON ST NE STE 150 PMB 3524
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City | ALBUQUERQUE
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State | NM
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Zip | 87109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | FIONA VERONICA GOODELL
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Credential | MS, CCC-SLP
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Telephone | 386-481-0590
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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 |
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License Number State |
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