Active NPI
Ivonne Olson Penuela, SLP-CF
- Speech-Language Pathologist
- Vado, NM
National Provider Identifier
1952850307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- C-6086
- Practice address
- 330 Holguin Rd
Vado, NM 88072-7220 - Phone
- (575) 233-2861
- NPI assigned
- Sep 27, 2016
- Last updated
- Sep 27, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 | C-6086 | NM | Primary |
Addresses
Primary practice location
330 Holguin Rd
Vado, NM 88072-7220
Mailing address
PO Box 70
Anthony, NM 88021-0070
Phone (575) 882-6101
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-6086 | NM | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gadsden Independent School District | Past | Accepting new patients | |
| Gadsden Independent School District | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Local Education Agency (LEA)
- Santa Teresa, NM
- NPI 1104173095
-
- Local Education Agency (LEA)
- Sunland Park, NM
- NPI 1114143393
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474934400000",
"number": "1952850307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 70",
"city": "ANTHONY",
"state": "NM",
"postal_code": "880210070",
"telephone_number": "575-882-6101",
"fax_number": "575-882-6926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 HOLGUIN RD",
"city": "VADO",
"state": "NM",
"postal_code": "880727220",
"telephone_number": "575-233-2861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON PENUELA",
"first_name": "IVONNE",
"credential": "SLP-CF",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-27",
"last_updated": "2016-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "C-6086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vado, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.