Provider Demographics
NPI:1154519726
Name:SANKOVITZ, THERESE M (AUD)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:SANKOVITZ
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 1:2340 HIGHWAY 180 E
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7782
Mailing Address - Country:US
Mailing Address - Phone:575-993-9849
Mailing Address - Fax:575-652-5284
Practice Address - Street 1:1016 NORTH POPE STREET
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-993-9849
Practice Address - Fax:575-652-5284
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAUD5888231H00000X
WI23-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist