Active NPI
Michelle Renee Bourguet-Jio, MS,CCC-SLP
- Speech-Language Pathologist
- Laguna, NM
National Provider Identifier
1114141306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 3427
- Practice address
- I-40 West Exit 114 Travel Rd 55
Laguna, NM 87026 - Phone
- (505) 552-9091
- NPI assigned
- Apr 12, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 3427 | NM | Primary |
Addresses
Primary practice location
I-40 West Exit 114 Travel Rd 55
Laguna, NM 87026
Mailing address
7420 Twisted Branch St NE
Albuquerque, NM 87113-0002
Phone (505) 345-1619
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3427 | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114141306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7420 TWISTED BRANCH ST NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871130002",
"telephone_number": "505-345-1619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "I-40 WEST EXIT 114 TRAVEL RD 55",
"city": "LAGUNA",
"state": "NM",
"postal_code": "87026",
"telephone_number": "505-552-9091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURGUET-JIO",
"first_name": "MICHELLE",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "MS,CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "3427",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laguna, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.