Kaitlynn Wallace
Individual provider Active NPI Speech-Language Pathologist · Portales, NM
NPI 1790249100 · NPPES record last updated Jul 27, 2021
Key facts
- NPI
- 1790249100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- 1500 S Ave K
Station 3, Shroc
Portales, NM 88130 - Phone
- (575) 562-2156
- NPI assigned
- Jan 30, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern New Mexico University | Speech-Language Pathologist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | CA | ||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Speech-Language Pathologist | 235Z00000X | Yes |
Addresses
Primary practice location
1500 S Ave K
Station 3, Shroc
Portales, NM 88130
Mailing address
3319 E Forest Lake Rd
Acampo, CA 95220-9573
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Kaitlynn.wallace@enmu.edu |
Other providers in Portales, NM
- Juliann R Villanueva
- Alana Villegas
- Kimmberly Viscaino
- Whitnee Wade
- Wal-Mart Stores East LP
- Cristy Janese Walsh
- Makenzi J Walthers
- Scott Owen Washburn
- Katelynn Grace Webb
- Laura A West
All providers in Portales, 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 27, 2021. 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.