Healthcare Provider Details

I. General information

NPI: 1710833033
Provider Name (Legal Business Name): CARRIE J. SPACKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4379
US

IV. Provider business mailing address

6801 JEFFERSON ST NE STE
ALBUQUERQUE NM
87109-4379
US

V. Phone/Fax

Practice location:
  • Phone: 505-444-5111
  • Fax: 505-944-1927
Mailing address:
  • Phone: 505-444-5111
  • Fax: 505-944-1927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: