Basic Information
| Provider Information | |||||||||
| NPI: | 1730625575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEROLA | ||||||||
| FirstName: | ELAINE | ||||||||
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| Credential: | M.S., CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 CALLE DE ORIENTE NORTE | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875075148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605810014 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5200 COPPER AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871081473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052665557 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2017 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | CF7896 | NM | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.