Provider Demographics
NPI:1568539005
Name:HACKNEY, MAXINE (SLP)
Entity Type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:
Last Name:HACKNEY
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 1:7112-89 PAN AMERICAN EAST FWY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4236
Mailing Address - Country:US
Mailing Address - Phone:505-884-9736
Mailing Address - Fax:
Practice Address - Street 1:4720 CAIRO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2617
Practice Address - Country:US
Practice Address - Phone:505-296-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist