Michelle Renee Bourguet-Jio, MS,CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Laguna, NM
NPI 1114141306 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1114141306
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 3427 (NM)
- Practice address
- I-40 West Exit 114 Travel Rd 55
Laguna, NM 87026 - Phone
- (505) 552-9091
- NPI assigned
- Apr 12, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3427 | NM | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 3427 | NM | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 96551828 | Medicaid | NM |
Other providers in Laguna, NM
All providers in Laguna, NM · Speech-Language Pathologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.