Provider Demographics
NPI:1144572330
Name:KOTEEN, ANTONETTE MARIE (MS SLP)
Entity Type:Individual
Prefix:MS
First Name:ANTONETTE
Middle Name:MARIE
Last Name:KOTEEN
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 INEZ DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5529
Mailing Address - Country:US
Mailing Address - Phone:505-818-7320
Mailing Address - Fax:
Practice Address - Street 1:4821 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1226
Practice Address - Country:US
Practice Address - Phone:505-818-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist