Provider Demographics
NPI:1306096359
Name:AYCOCK, MINDY LEIGH (MS)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:LEIGH
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LASER DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4517
Mailing Address - Country:US
Mailing Address - Phone:505-994-3305
Mailing Address - Fax:
Practice Address - Street 1:500 LASER DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4517
Practice Address - Country:US
Practice Address - Phone:505-994-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist