Provider Demographics
NPI:1922981190
Name:SAUVAGEAU, MARY WYNN (AUD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:WYNN
Last Name:SAUVAGEAU
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 RODEO RD APT 320
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6857
Mailing Address - Country:US
Mailing Address - Phone:864-901-9698
Mailing Address - Fax:
Practice Address - Street 1:435 SAINT MICHAELS DR STE B104
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7671
Practice Address - Country:US
Practice Address - Phone:505-946-3955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSAH-2025-0136231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist