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NPI Code Detail

MEDICARE: MARIA LESLIE WANDEMBERG

MEDICARE: MARIA LESLIE WANDEMBERG
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
1235Z00000XSpeech-Language Pathologist5252NM

General Provider Information

NPI Number : 1669754990
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA LESLIE WANDEMBERG
Provider Business Mailing Address
First Line : 301 PERKINS DR STE B
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-3248
Country : US
Telephone Number : 575-526-6682
Fax Number : 575-523-7254
Provider Business Practice Location Address
First Line : 1681 HICKORY LOOP
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-6587
Country : US
Telephone Number : 575-526-6682
Fax Number : 575-523-7254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2011
Last Update Date : 12/17/2025

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Directions to “ MARIA LESLIE WANDEMBERG ” Practice Location

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