| Doctor Name: | CANDICE D TETREAULT |
| NPI Number: | 1053757237 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS/CCC-SLP |
| License Number: | NCSLP-10331 |
| Business Practice Address: | 4811-e Hardware Dr. Ne Albuquerque, NM - 87109 |
| Business Phone Number: | 5052685933 |
| Business Fax Number: | 5052680184 |
| Mailing Address: | 15 Forest Rd, TIJERAS |
| State: | NM |
| Postal Code: | 870597447 |
| Phone Number: | 9108139964 |
| Fax Number: | |
| NPI Enumeration Date: | 05/15/2013 |
| NPI Last Update Date: | 12/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | NCSLP-10331 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |