Individual
EVA MAE BLAKELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS/CCC-SLP
Contact information
Practice address
1090 MOUNTAIN VALLEY RD, EDGEWOOD, NM 87015-8044
(505) 281-1811
(505) 281-7704
Mailing address
PO BOX 2225, EDGEWOOD, NM 87015-2225
(505) 281-1811
(505) 281-7704
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6153
NM
Other
Enumeration date
02/27/2017
Last updated
02/27/2017
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