| Doctor Name: | TRISTA N BLADE |
| NPI Number: | 1962741843 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC-SLP |
| License Number: | 9052 |
| Business Practice Address: | 14130 23rd Avenue North Plymouth, MN - 554474904 |
| Business Phone Number: | 7633837666 |
| Business Fax Number: | 7633836013 |
| Mailing Address: | 14130 23rd Avenue North, PLYMOUTH |
| State: | MN |
| Postal Code: | 554474904 |
| Phone Number: | 7633837666 |
| Fax Number: | 7633836013 |
| NPI Enumeration Date: | 02/12/2013 |
| NPI Last Update Date: | 01/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 9052 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| 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 |