Individual
KENNETH W HODDER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
1100 ALAMEDA BLVD NW, ALBUQUERQUE, NM 87114-1937
(505) 897-7883
(505) 792-8578
Mailing address
1100 ALAMEDA BLVD NW, ALBUQUERQUE, NM 87114-1937
(505) 897-7883
(505) 792-8578
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I-2148
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NM00R32L
BLUE CROSS BLUE SHIELD
NM
01
—
105879
MHN
NM
01
—
860663612 0001
CIGNA HEALTHCARE
NM
01
—
86066361287114A001
TRIWEST HEALTHCARE ALLIAN
NM
05
—
NM10005
—
NM
Enumeration date
05/18/2006
Last updated
07/09/2007
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