Provider Demographics
NPI:1841850385
Name:ETHRIDGE, SUNDARI MICHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUNDARI
Middle Name:MICHELLE
Last Name:ETHRIDGE
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 1:4811 HARDWARE DR NE # 1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2017
Mailing Address - Country:US
Mailing Address - Phone:575-707-3527
Mailing Address - Fax:
Practice Address - Street 1:4811 HARDWARE DR NE # 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2017
Practice Address - Country:US
Practice Address - Phone:505-268-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP7051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist