| Doctor Name: | MS. RUTH PAULINE DISMUKE BLAKELY |
| NPI Number: | 1316070188 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | 2880 |
| Business Practice Address: | 1090 Mountain Valley Rd Edgewood, NM - 870158044 |
| Business Phone Number: | 5052811811 |
| Business Fax Number: | 5052817704 |
| Mailing Address: | Po Box 2225, EDGEWOOD |
| State: | NM |
| Postal Code: | 870152225 |
| Phone Number: | 5052811811 |
| Fax Number: | 5052817704 |
| NPI Enumeration Date: | 03/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2880 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| 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 |