Provider Demographics
NPI:1528532801
Name:PODRUCHNY, DACIA RAQUEL I (MS SLP-CF)
Entity type:Individual
Prefix:MISS
First Name:DACIA
Middle Name:RAQUEL
Last Name:PODRUCHNY
Suffix:I
Gender:F
Credentials:MS SLP-CF
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Mailing Address - Street 1:2921 VALLE VIS
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4824
Mailing Address - Country:US
Mailing Address - Phone:915-433-6608
Mailing Address - Fax:
Practice Address - Street 1:4950 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9621
Practice Address - Country:US
Practice Address - Phone:575-882-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSAH-2024-0365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist