Doctor Name: | MR. MICHAEL TODD BLACKBURN |
NPI Number: | 1114277662 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A., CCC-SLP |
License Number: | 415854R |
Business Practice Address: | 502 4th St Ne Auburn, WA - 980025020 |
Business Phone Number: | 2539314927 |
Business Fax Number: | 2539314742 |
Mailing Address: | 502 4th St Ne, AUBURN |
State: | WA |
Postal Code: | 980025020 |
Phone Number: | 2539314927 |
Fax Number: | 2539314742 |
NPI Enumeration Date: | 09/12/2012 |
NPI Last Update Date: | 09/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 415854R |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
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 |