Headwaters Pediatric Therapies, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

HEADWATERS PEDIATRIC THERAPIES, LLC

Practice address

8405 La Ventura CT NW
Albuquerque, NM 87120-5352

Phone

(505) 610-4076

NPI assigned

Sep 14, 2026

Last updated

Sep 14, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shannon Carryn Troutman, CCC-SLP

Title

Speech-Language Pathologist

Phone

(505) 610-4076

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1789344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789344000000",
    "number": "1598676314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8405 LA VENTURA CT NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871205352",
            "telephone_number": "505-610-4076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8405 LA VENTURA CT NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871205352",
            "telephone_number": "505-610-4076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEADWATERS PEDIATRIC THERAPIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-14",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-13",
        "status": "A",
        "authorized_official_last_name": "TROUTMAN",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "CARRYN",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "505-610-4076",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; 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.