Provider Demographics
NPI:1548513419
Name:MENDE, LINDA MIKA
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MIKA
Last Name:MENDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 CALLE MEJIA APT 805
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1466
Mailing Address - Country:US
Mailing Address - Phone:301-442-4225
Mailing Address - Fax:
Practice Address - Street 1:714 CALLE DON DIEGO
Practice Address - Street 2:ESPANOLA PUBLIC SCHOOLS
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532
Practice Address - Country:US
Practice Address - Phone:505-753-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2054103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM352581OtherSTATE OF NEW MEXICO SCHOOL PERSONNEL LICENSE - L1 PREK-12 SCHOOL PSYCHOLOGIST
35678OtherNATIONALLY CERTIFIED SCHOOL PSYCHOLOGIST
2054OtherMARYLAND EDUCATOR CERTIFICATE: ADVANCED PROF CERTIFICATE - SCHOOL PSYCHOLOGIST