Individual
ETHELINE JOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
5700 HENDRIX RD NE, GOVENOR BENT ES, ALBUQUERQUE, NM 87110-1257
(505) 831-9797
Mailing address
5700 HENDRIX RD NE, GOVENOR BENT ES, ALBUQUERQUE, NM 87110-1257
(505) 831-9797
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
NONE ASSIGNED
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NONE ASSIGNED
—
NM
Enumeration date
08/27/2012
Last updated
08/27/2012
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