Provider Demographics
NPI:1679584833
Name:GIVENS, ALAN DALE (MS CCC-SLP/AUD)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DALE
Last Name:GIVENS
Suffix:
Gender:M
Credentials:MS CCC-SLP/AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2461
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88311-2461
Mailing Address - Country:US
Mailing Address - Phone:505-491-8898
Mailing Address - Fax:
Practice Address - Street 1:1090 MED PARK DR.
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3236
Practice Address - Country:US
Practice Address - Phone:575-523-7243
Practice Address - Fax:575-525-5641
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5702231H00000X
TX11247235Z00000X
NM2622235Z00000X
NMSLP2622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist