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Individual

CONNIE CASSIDY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
6400 UPTOWN BLVD NE, MEDICAID, ALBUQUERQUE, NM 87110-4204
(505) 880-3700
Mailing address
6316 CONSTITUTION AVE NE, ALBUQUERQUE, NM 87110-5944
(505) 255-8337

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2689
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000B6698
NM
Enumeration date
01/15/2007
Last updated
07/09/2007
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