Provider Demographics
NPI:1053406975
Name:TROUT, MICHAEL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TROUT
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 MICHELANGELO LN NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5016
Mailing Address - Country:US
Mailing Address - Phone:505-269-5241
Mailing Address - Fax:505-830-0106
Practice Address - Street 1:2819 RICHMOND DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1918
Practice Address - Country:US
Practice Address - Phone:505-883-3787
Practice Address - Fax:505-830-0106
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-3849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM62682873Medicaid
NM10026771OtherLOVELACE HEALTH PLAN
NMQMYPR0072405OtherMOLINA HEALTH CARE