NPIMap

Organization Active NPI

Sophie R. Wagner, NM Speech-Language Pathologist, LLC

  • Hearing and Speech Clinic/Center
  • Albuquerque, NM
National Provider Identifier
1144640947
Registry record updated Sep 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing and Speech Clinic/CenterTaxonomy code 261QH0700X
License
5431 Issued in NM
Legal business name
SOPHIE R. WAGNER, NM SPEECH-LANGUAGE PATHOLOGIST, LLC
Practice address
1503 Central Ave NW
Unit 202
Albuquerque, NM 87104-1180
Phone
(505) 401-8204
Fax
(505) 232-3588
NPI assigned
Apr 18, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2014

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

Authorized official

Name
Ms. Caryn Wagner
Title
Office Manager
Phone
(505) 980-5334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing and Speech Clinic/Center 261QH0700X 5431 NM Primary

Addresses

Primary practice location

1503 Central Ave NW
Unit 202
Albuquerque, NM 87104-1180

Mailing address

1503 Central Ave NW
Unit 202
Albuquerque, NM 87104-1180
Phone (505) 401-8204

Other identifiers 3

IdentifierTypeStateIssuer
81888228OtherNMMEDICAID, INDIVIDUAL PROVIDER ID, NOT BILLING PROVIDER ID
47631597MedicaidNM
03272176005OtherNMCRS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1397779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1144640947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 CENTRAL AVE NW",
            "address_2": "UNIT 202",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871041180",
            "telephone_number": "505-401-8204",
            "fax_number": "505-232-3588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 CENTRAL AVE NW",
            "address_2": "UNIT 202",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871041180",
            "telephone_number": "505-401-8204",
            "fax_number": "505-232-3588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOPHIE R. WAGNER, NM SPEECH-LANGUAGE PATHOLOGIST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-18",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "CARYN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-980-5334",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "NM",
            "license": "5431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID, INDIVIDUAL PROVIDER ID, NOT BILLING PROVIDER ID",
            "identifier": "81888228",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47631597",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRS",
            "identifier": "03272176005",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; 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.