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Organization
ONLINE SPECH THERAPY P.C.
Active
Organization
ONLINE SPECH THERAPY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADISON BLAYLOCK SLP (PRESIDENT)
(417) 438-8931
Entity
Organization
Contact information
Practice address
1330 CONNECTICUT ST, IMPERIAL BEACH, CA 91932-3224
(417) 438-8931
Mailing address
1330 CONNECTICUT ST, IMPERIAL BEACH, CA 91932-3224
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
12/20/2023
Last updated
12/20/2023
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