Provider Demographics
NPI:1023604147
Name:RIO GRANDE SPEECH, VOICE AND SWALLOWING, LLC
Entity type:Organization
Organization Name:RIO GRANDE SPEECH, VOICE AND SWALLOWING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. AMAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:603-440-8312
Mailing Address - Street 1:5320 HERITAGE WAY NE APT C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3225
Mailing Address - Country:US
Mailing Address - Phone:603-440-8312
Mailing Address - Fax:
Practice Address - Street 1:5320 HERITAGE WAY NE APT C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3225
Practice Address - Country:US
Practice Address - Phone:603-440-8312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty