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NPI Code Detail

MEDICARE: HOPE BODEWALDT

MEDICARE: HOPE BODEWALDT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1043882624
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOPE BODEWALDT
Provider Business Mailing Address
First Line : 10899 MONTGOMERY BLVD NE STE B
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-3935
Country : US
Telephone Number : 505-544-6330
Fax Number : 505-214-5253
Provider Business Practice Location Address
First Line : 10899 MONTGOMERY BLVD NE STE B
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-3935
Country : US
Telephone Number : 505-544-6330
Fax Number : 505-214-5253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2021
Last Update Date : 07/13/2021

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Directions to “ HOPE BODEWALDT ” Practice Location

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