1073096772 NPI number — MRS. EMILY RUTH ROBERTS BS, MS,

Table of content: MRS. EMILY RUTH ROBERTS BS, MS, (NPI 1073096772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073096772 NPI number — MRS. EMILY RUTH ROBERTS BS, MS,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
EMILY
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BS, MS,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRISON
Provider Other First Name:
EMILY
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BS.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073096772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W ROSS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87401-5861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-360-7044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 MCCORMICK SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87401-7141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-599-8606
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14194832 . This is a "AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: SLP6534 . This is a "SPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY, AND HEARING AID DISPENSING PRACTICES BOARD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 380729 . This is a "NEW MEXICO PUBLIC EDUCATION DEPARTMENT" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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