Provider Demographics
NPI:1598898058
Name:EICHWALD, MARIE ANTONETTE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ANTONETTE
Last Name:EICHWALD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:M.
Other - Middle Name:ANTONETTE
Other - Last Name:SALAZAR EICHWALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M S CCC-SLP
Mailing Address - Street 1:481 PLAZA VINEDOS
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6610
Mailing Address - Country:US
Mailing Address - Phone:505-771-0971
Mailing Address - Fax:505-771-0971
Practice Address - Street 1:481 PLAZA VINEDOS
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6610
Practice Address - Country:US
Practice Address - Phone:505-771-0971
Practice Address - Fax:505-771-0971
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1997235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD2185Medicaid