Individual
MRS. JACQUELINE A TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3530 PAN AMERICAN FWY NE STE D, ALBUQUERQUE, NM 87107-4793
(505) 888-4469
(505) 889-8142
Mailing address
3530 PAN AMERICAN FWY NE STE D, ALBUQUERQUE, NM 87107-4793
(505) 888-4469
(505) 889-8142
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1592
NM
Other
Enumeration date
05/01/2012
Last updated
05/01/2012
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