| Doctor Name: | MARIA ELISSA WANDEMBERG |
| NPI Number: | 1023395126 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. |
| License Number: | C-4919 |
| Business Practice Address: | 505 S Main St Ste 249 Las Cruces, NM - 880011243 |
| Business Phone Number: | 5755275884 |
| Business Fax Number: | |
| Mailing Address: | 1774 Imperial Rdg, LAS CRUCES |
| State: | NM |
| Postal Code: | 880114810 |
| Phone Number: | 5755710207 |
| Fax Number: | |
| NPI Enumeration Date: | 11/03/2011 |
| NPI Last Update Date: | 11/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | C-4919 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |