Provider Demographics
NPI:1841414729
Name:HAZLEWOOD, ABBIE J (MS CCC A FAAA)
Entity Type:Individual
Prefix:MS
First Name:ABBIE
Middle Name:J
Last Name:HAZLEWOOD
Suffix:
Gender:F
Credentials:MS CCC A FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W MAPLE ST
Mailing Address - Street 2:DEPARTMENT OF AUDIOLOGY
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5630
Mailing Address - Country:US
Mailing Address - Phone:505-599-6169
Mailing Address - Fax:505-324-6841
Practice Address - Street 1:801 W MAPLE ST
Practice Address - Street 2:DEPARTMENT OF AUDIOLOGY
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5630
Practice Address - Country:US
Practice Address - Phone:505-599-6169
Practice Address - Fax:505-324-6841
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM231A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK1758Medicaid