| Doctor Name: | DR. MARLENE B SALAS-PROVANCE |
| NPI Number: | 1366758393 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 3836 |
| Business Practice Address: | 1405 International Mall Speech Bldg. Room 158 Las Cruces, NM - 880031279 |
| Business Phone Number: | 5756463906 |
| Business Fax Number: | |
| Mailing Address: | P.o. Box 30001/msc 3spe, LAS CRUCES |
| State: | NM |
| Postal Code: | 880038001 |
| Phone Number: | 5756462364 |
| Fax Number: | |
| NPI Enumeration Date: | 08/27/2010 |
| NPI Last Update Date: | 08/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 3836 |
| 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 |