Provider Demographics
NPI:1841350667
Name:ZELLNER, MONICA RENAE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:RENAE
Last Name:ZELLNER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 BRYAN AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5858
Mailing Address - Country:US
Mailing Address - Phone:505-620-0541
Mailing Address - Fax:505-899-2218
Practice Address - Street 1:4101 BRYAN AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5858
Practice Address - Country:US
Practice Address - Phone:505-620-0541
Practice Address - Fax:505-899-2218
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30074851OtherDD AND MF WAIVER NUMBER