Most Relevant Information
Provider Data
| NPI Number: | 1003332990 |
| Provider Name: | KATELYN ANNE FERGUSON |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/22/2017 |
| Last Updated: | 03/22/2019 |
Provider Practice Location
1000 E AZTEC AVE
GALLUP
NM
873015509
Practice Location Phone/Fax
| Phone: | 5057211807 |
| Fax: | 5057211899 |
Provider Mailing Location
1500 S AVE K
STATION 3, SHROC
PORTALES
NM
88130
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |