Provider Demographics
NPI:1447835723
Name:BERTRAM, ELIZABETH (CF)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BERTRAM
Suffix:
Gender:F
Credentials:CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 MCMAHON BLVD NW STE 200
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5090
Mailing Address - Country:US
Mailing Address - Phone:505-554-1734
Mailing Address - Fax:505-521-5161
Practice Address - Street 1:4801 MCMAHON BLVD NW STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5090
Practice Address - Country:US
Practice Address - Phone:505-554-1734
Practice Address - Fax:505-521-5161
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCF7246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist