Doctor Name: | MR. PHILIP DAVID BLALOCK |
NPI Number: | 1154743383 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | SPEECH PATHOLOGIST |
License Number: | 439 |
Business Practice Address: | Wake Forest Baptist Health Medical Center Blvd Winston Salem, NC - 271570001 |
Business Phone Number: | 3367168207 |
Business Fax Number: | 3367168868 |
Mailing Address: | Wake Forest Baptist Health Medical Center Blvd, WINSTON SALEM |
State: | NC |
Postal Code: | 271570001 |
Phone Number: | 3367168207 |
Fax Number: | 3367168868 |
NPI Enumeration Date: | 01/07/2014 |
NPI Last Update Date: | 01/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 439 |
Healthcare Provider Taxonomy: (Secondary) | Y |
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 |