Basic Information
| Provider Information | |||||||||
| NPI: | 1164524187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HATTLER | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | CCCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 GIBSON BLVD SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871084729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052627960 | ||||||||
| FaxNumber: | 5052321368 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 GIBSON BLVD SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871084729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052623277 | ||||||||
| FaxNumber: | 5052627216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 075 | NM | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.