Provider Demographics
NPI:1205955655
Name:METHENEY, ANTOINETTE C (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:C
Last Name:METHENEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10220 SHAWNA ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3560
Mailing Address - Country:US
Mailing Address - Phone:505-459-8082
Mailing Address - Fax:
Practice Address - Street 1:10220 SHAWNA ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3560
Practice Address - Country:US
Practice Address - Phone:505-459-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist