Provider Demographics
NPI:1588729107
Name:BUCKELS, WENDY DENISE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:DENISE
Last Name:BUCKELS
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 1:2410 VENETIAN WAY SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-7236
Mailing Address - Country:US
Mailing Address - Phone:505-610-7020
Mailing Address - Fax:866-848-6905
Practice Address - Street 1:2410 VENETIAN WAY SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-7236
Practice Address - Country:US
Practice Address - Phone:505-255-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD3884Medicaid