Active NPI
Tracey Poffenroth Prato, SLP
- Speech-Language Pathologist
- Taos, NM
National Provider Identifier
1609146315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 3261
- Practice address
- 208 Paseo del Pueblo Sur Unit 104
Taos, NM 87571-5931 - Phone
- (505) 514-2588
- NPI assigned
- Jan 11, 2012
- Last updated
- Dec 22, 2023
- 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 | 3261 | NM | Primary |
Addresses
Primary practice location
208 Paseo del Pueblo Sur Unit 104
Taos, NM 87571-5931
Mailing address
PO Box 3861
Taos, NM 87571-3861
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4056 | NM | MD | Physical Therapist |
| 3261 | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703203200000",
"number": "1609146315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3861",
"city": "TAOS",
"state": "NM",
"postal_code": "875713861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 PASEO DEL PUEBLO SUR UNIT 104",
"city": "TAOS",
"state": "NM",
"postal_code": "875715931",
"telephone_number": "505-514-2588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POFFENROTH PRATO",
"first_name": "TRACEY",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-11",
"last_updated": "2023-12-22",
"certification_date": "2023-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "3261",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Taos, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.