| Doctor Name: | MARY ELIZABETH WALL |
| NPI Number: | 1780826636 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1057 |
| Business Practice Address: | 7 Coyote Court Box 2290 Rdt, Nm 87557 Taos, NM - 87571 |
| Business Phone Number: | 5757585763 |
| Business Fax Number: | |
| Mailing Address: | Po Box 2290, RANCHOS DE TAOS |
| State: | NM |
| Postal Code: | 875572290 |
| Phone Number: | 5757585763 |
| Fax Number: | |
| NPI Enumeration Date: | 03/24/2009 |
| NPI Last Update Date: | 03/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 1057 |
| 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 |