Lundergan, Mia H
Lundergan, Mia H is an sole proprietor health care provider with primary practice located at 901 Douglas Ave , Las Vegas NM 87701-3928. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Lundergan, Mia H can be contacted via phone (505) 454-5700.Contact Information
Primary practice address
901 Douglas Ave
Las Vegas NM 87701-3928
Phone: (505) 454-5700
Fax: (505) 454-5702
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | 564 | New Mexico |
Profile Details
| NPI number | 1851424196 |
|---|---|
| LBN Legal business name | Lundergan, Mia H |
| Credentials | MA CCC SLP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 14th, 2007 |
| Last updated | Jul 9th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1851424196 | NPPES |
| New Mexico | MEDICAID | 235Z00000X |
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