Provider Demographics
NPI:1396211249
Name:GENTRY, CAITLYNNE MARIE (AUD)
Entity Type:Individual
Prefix:MISS
First Name:CAITLYNNE
Middle Name:MARIE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 CORRALES RD NW STE I
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-9255
Mailing Address - Country:US
Mailing Address - Phone:505-890-0003
Mailing Address - Fax:505-221-5757
Practice Address - Street 1:10700 CORRALES RD NW STE I
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-9255
Practice Address - Country:US
Practice Address - Phone:505-890-0003
Practice Address - Fax:505-221-5757
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6636231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist