Active NPI
Etheline Jose, SLP
- Speech-Language Pathologist
- Albuquerque, NM
National Provider Identifier
1023366937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- NONE ASSIGNED
- Practice address
- 5700 Hendrix Rd NE
Govenor Bent Es
Albuquerque, NM 87110-1257 - Phone
- (505) 831-9797
- NPI assigned
- Aug 27, 2012
- Last updated
- Aug 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | NONE ASSIGNED | NM | Primary |
Addresses
Primary practice location
5700 Hendrix Rd NE
Govenor Bent Es
Albuquerque, NM 87110-1257
Mailing address
5700 Hendrix Rd NE
Govenor Bent Es
Albuquerque, NM 87110-1257
Phone (505) 831-9797
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE ASSIGNED | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NONE ASSIGNED | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346025600000",
"number": "1023366937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5700 HENDRIX RD NE",
"address_2": "GOVENOR BENT ES",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871101257",
"telephone_number": "505-831-9797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5700 HENDRIX RD NE",
"address_2": "GOVENOR BENT ES",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871101257",
"telephone_number": "505-831-9797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOSE",
"first_name": "ETHELINE",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-27",
"last_updated": "2012-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "NONE ASSIGNED",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NONE ASSIGNED",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
- Therese Ann Jordan, LISW
- Jan Emmanuel Anthony Empleo Jorgio
- Ingrid Jorud, MS, RD, LD, CPT
- Jose Guzman RDN LLC (Viva Real Renal Care)
- Clement Jose, MD
- Vanessa Elaine Josef, MD
- Joseph F Hollinger MD PC
- Joseph M Molina MD Professional Corporation - Southern California Moli (Molina Medical Group of Southern California)
- Joseph M Molina MD Professional Corporation-Southern California (Molina Medical Group of Southern CA)
- Joseph Miller & Associates LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.