MEDICARE: MARGIE G. MEDINA M.A., CCC-SLP

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	5001	NM

General Provider Information

NPI Number	:	1841567930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGIE G. MEDINA M.A., CCC-SLP

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	:	575-647-3773
Fax Number	:

Provider Business Practice Location Address
First Line	:	1681 HICKORY LOOP
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-6587
Country	:	US
Telephone Number	:	575-647-3773
Fax Number	:	575-647-3777

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

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	12/27/2022

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Directions to “ MARGIE G. MEDINA M.A., CCC-SLP” Practice Location

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