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General NPI Number Information
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NPI Number | 1962040584
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Entity Type | Individual
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Provider Name | ALLISON IACOCCA
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Gender | Female
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 100 E MARKET ST
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City | SILVER CITY
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State | NM
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Zip | 88061-5450
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Country | US
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Telephone | 828-482-6344
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 405
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City | CLIFF
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State | NM
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Zip | 88028-0405
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Country | US
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Telephone | 575-654-2919
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | X-11244
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License Number State | NM
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