Basic Information
| Provider Information | |||||||||
| NPI: | 1285150607 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUJILLO | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25704 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871250704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058559893 | ||||||||
| FaxNumber: | 5058489468 | ||||||||
| Practice Location | |||||||||
| Address1: | 6400 UPTOWN BLVD NE STE 360W | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871104202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058559893 | ||||||||
| FaxNumber: | 5058489468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 08/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 6196 | NM | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.