Individual
JACQUELINE CHACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-2455
Mailing address
PO BOX 642, SOCORRO, NM 87801-0642
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP5924
NM
Other
Enumeration date
10/09/2014
Last updated
03/04/2024
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