Provider Demographics
NPI:1467416438
Name:AMENDOLAGINE, MARCIE L (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:L
Last Name:AMENDOLAGINE
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:L
Other - Last Name:STOCKBOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC/SLP
Mailing Address - Street 1:730 SOLAR RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5746
Mailing Address - Country:US
Mailing Address - Phone:505-343-9556
Mailing Address - Fax:
Practice Address - Street 1:730 SOLAR RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5746
Practice Address - Country:US
Practice Address - Phone:505-343-9556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist