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NPI Code Detail

MEDICARE: MR. ALAN DALE GIVENS M.S. CCC-SLP/AUD

MEDICARE: MR. ALAN DALE GIVENS M.S. CCC-SLP/AUD
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
1231H00000XAudiologist5702NM
2235Z00000XSpeech-Language Pathologist11247TX
3235Z00000XSpeech-Language Pathologist2622NM
4235Z00000XSpeech-Language PathologistSLP2622NM

General Provider Information

NPI Number : 1679584833
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALAN DALE GIVENS M.S. CCC-SLP/AUD
Provider Business Mailing Address
First Line : PO BOX 2461
Second Line :
City : ALAMOGORDO
State : NM
Zip : 88311-2461
Country : US
Telephone Number : 505-491-8898
Fax Number :
Provider Business Practice Location Address
First Line : 1090 MED PARK DR.
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-3236
Country : US
Telephone Number : 575-523-7243
Fax Number : 575-525-5641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 04/20/2022

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