Provider Demographics
NPI:1407031495
Name:MCCURLEY BRATTON, DOROTHY ELLEN (AUD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ELLEN
Last Name:MCCURLEY BRATTON
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 1:457 WASHINGTON ST SE
Mailing Address - Street 2:STE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2713
Mailing Address - Country:US
Mailing Address - Phone:505-243-8030
Mailing Address - Fax:505-212-4221
Practice Address - Street 1:457 WASHINGTON ST SE
Practice Address - Street 2:STE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2713
Practice Address - Country:US
Practice Address - Phone:505-243-8030
Practice Address - Fax:505-212-4221
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM443231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK1766Medicaid