| Doctor Name: | MRS. AMY DENISE BLACKBURN |
| NPI Number: | 1447497516 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MCD, CFY-SLP |
| License Number: | 2008037336 |
| Business Practice Address: | 1110 N Westwood Blvd Poplar Bluff, MO - 639013336 |
| Business Phone Number: | 5737856707 |
| Business Fax Number: | |
| Mailing Address: | 765 Highway F, HARVIELL |
| State: | MO |
| Postal Code: | 639458127 |
| Phone Number: | 5737768203 |
| Fax Number: | |
| NPI Enumeration Date: | 01/12/2009 |
| NPI Last Update Date: | 01/12/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2008037336 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| 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 |