Connie Hernandez
Individual provider Active NPI Speech-Language Pathologist · Bloomfield, NM
NPI 1568500833 · NPPES record last updated Aug 13, 2014
Key facts
- NPI
- 1568500833
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 2580 (NM)
- Practice address
- 325 North Bergin Lane
Bloomfield, NM 87413-2430 - Phone
- (505) 632-4300
- NPI assigned
- Feb 1, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2580 | NM | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2580 | NM | Yes |
Addresses
Primary practice location
325 North Bergin Lane
Bloomfield, NM 87413-2430
Mailing address
1230 La Loma Road
Anton Chico, NM 87711-9501
Phone (575) 427-8026
Other providers in Bloomfield, NM
- Bryan Wayne Harber
- Cheryl Hare
- Douglas K Harris
- Kathleen Henderson
- Christina L Herbig
- Roy Hernandez
- Ariel Rose Howard
- Colleen Hudson
- Thomas William Hurst
- Jessica Iudiciani
All providers in Bloomfield, 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 Aug 13, 2014. 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.