Provider Demographics
NPI:1619147568
Name:ENTERMAN, CHRIS A (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:A
Last Name:ENTERMAN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 PUEBLO HAWIKUH
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2514
Mailing Address - Country:US
Mailing Address - Phone:505-690-7221
Mailing Address - Fax:
Practice Address - Street 1:3105 PUEBLO HAWIKUH
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2514
Practice Address - Country:US
Practice Address - Phone:505-690-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073661336OtherEMPLOYER NPI
NM95475524Medicaid