Provider Demographics
NPI:1376879817
Name:HUNLEY, JODI ANN
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ANN
Last Name:HUNLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 CHILDERS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2826
Mailing Address - Country:US
Mailing Address - Phone:505-459-8957
Mailing Address - Fax:
Practice Address - Street 1:4011 BARBARA LOOP SE STE 103
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1040
Practice Address - Country:US
Practice Address - Phone:505-891-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-071371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical