Provider Demographics
NPI:1508903493
Name:CUNICO, JULIETTE M (SLP)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:M
Last Name:CUNICO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 EDITH BLVD SE
Mailing Address - Street 2:EUGENE FIELD ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4226
Mailing Address - Country:US
Mailing Address - Phone:505-764-2014
Mailing Address - Fax:
Practice Address - Street 1:700 EDITH BLVD SE
Practice Address - Street 2:EUGENE FIELD ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4226
Practice Address - Country:US
Practice Address - Phone:505-764-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEJ 5086Medicaid