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Contact Information

PRISCILLA ROTH WALL, PhD
3751 N BUTLER AVE STE 115
FARMINGTON, NM87401-6425
 Phone: 505-787-2640
 Fax: 505-787-2789
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
 

Clinical Child & Adolescent

103TC2200X 62 Psychologist, Clinical
 

Intellectual & Developmental Disabilities

103TM1800X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for PRISCILLA ROTH WALL · (Female)

NPI Number 1457386963
Status Active
Credentials PhD
Entity Individual
Enumeration date 07/12/2006
Last updated 04/30/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • NM License # PSY1470
  • NM Medicaid 16970748
  • NM Other 73763700 MAGELLAN
  • NM Other PSY1470 PSYCHOLOGY LICENSE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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