Provider Demographics
NPI:1053733667
Name:BUCKNER, ARIEL
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 UPTOWN BLVD NE
Mailing Address - Street 2:STE 360 W
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4204
Mailing Address - Country:US
Mailing Address - Phone:505-855-9805
Mailing Address - Fax:505-848-9468
Practice Address - Street 1:6400 UPTOWN BLVD NE
Practice Address - Street 2:STE 360 W
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4204
Practice Address - Country:US
Practice Address - Phone:505-855-9805
Practice Address - Fax:505-848-9468
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist