Individual
CONNIE HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
325 NORTH BERGIN LANE, BLOOMFIELD, NM 87413-2430
(505) 632-4300
Mailing address
1230 LA LOMA ROAD, ANTON CHICO, NM 87711-9501
(575) 427-8026
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2580
NM
Other
Enumeration date
02/01/2007
Last updated
08/13/2014
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