Healthcare Provider Details

I. General information

NPI: 1629384227
Provider Name (Legal Business Name): WENDY BUCKELS & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 RIDGECREST DR SE
ALBUQUERQUE NM
87108-4439
US

IV. Provider business mailing address

1706 RIDGECREST DR SE
ALBUQUERQUE NM
87108-4439
US

V. Phone/Fax

Practice location:
  • Phone: 505-610-7020
  • Fax: 505-255-4311
Mailing address:
  • Phone: 505-610-7020
  • Fax: 505-255-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number914
License Number StateNM

VIII. Authorized Official

Name: MS. WENDY DENISE BUCKELS
Title or Position: OWNER
Credential: CCC-SLP
Phone: 505-610-7020