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NPI Code Detail

MEDICARE: MRS. COLLENE ALYCE LADD M.S., CCC-SLP

MEDICARE: MRS. COLLENE ALYCE LADD M.S., 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
1235Z00000XSpeech-Language Pathologist3294NM

General Provider Information

NPI Number : 1972713659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COLLENE ALYCE LADD M.S., CCC-SLP
Provider Business Mailing Address
First Line : 2400 UNSER BLVD SE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-3392
Country : US
Telephone Number : 505-253-7223
Fax Number : 505-253-1517
Provider Business Practice Location Address
First Line : 2400 UNSER BLVD SE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-3392
Country : US
Telephone Number : 505-253-7223
Fax Number : 505-253-1517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 01/19/2012

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Directions to “ MRS. COLLENE ALYCE LADD M.S., CCC-SLP” Practice Location

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