Susan Koller, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

662 Issued in NM

Practice address

2819 Richmond Dr NE
Albuquerque, NM 87107-1918

Phone

(505) 883-3787

Fax

(505) 830-0106

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Heartward Speech-Language Pathology, Inc.

  • Speech-Language Pathologist
  • Albuquerque, NM
  • NPI 1962597039
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1013002971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 MONROE ST NE UNIT I98",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871101873",
            "telephone_number": "505-980-4563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2819 RICHMOND DR NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871071918",
            "telephone_number": "505-883-3787",
            "fax_number": "505-830-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "SUSAN",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NM",
            "license": "662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65824563",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LOVELACE HEALTH PLAN",
            "identifier": "10026768",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA HEALTH CARE",
            "identifier": "QMYPR0072408",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natasha S Kolb, MD
• Tara Rochelle Kolberg, WHNP
• Melissa Kolkena, CNM, WHNP-BC
• Deborah Kolkmeyer, M.S, CDE
• Karla Elaine Kollasch, M.S., CCC-SLP
• Brooke Kollman, PA-C
• Kolomeir Clinic, LLC
• Maureen Kolomeir, RN, CNP
• Janice Lyn Koltonuk, LISW
• Christine Elisabeth Kolwitz, DO

• Speech-Language Pathologist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Speech-Language Pathologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.