Provider Demographics
NPI:1295011583
Name:MAREZ, DENISE P (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:P
Last Name:MAREZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 ACADEMY RD NE APT 1826
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7336
Mailing Address - Country:US
Mailing Address - Phone:505-238-8688
Mailing Address - Fax:
Practice Address - Street 1:9500 MONTGOMERY BLVD NE STE 215
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2579
Practice Address - Country:US
Practice Address - Phone:505-247-4224
Practice Address - Fax:505-247-1772
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMAPPLIED FORMedicaid
NMAPPLIED FORMedicare PIN