MEDICARE: ARDELL FITZGERALD MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1359	NM

General Provider Information

NPI Number	:	1003983578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARDELL FITZGERALD MA

Provider Business Mailing Address
First Line	:	7716 TRAIL RIDGE RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3213
Country	:	US
Telephone Number	:	505-821-9681
Fax Number	:

Provider Business Practice Location Address
First Line	:	2611 EUBANK BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1312
Country	:	US
Telephone Number	:	505-298-6752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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Directions to “ ARDELL FITZGERALD MA” Practice Location

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