Individual
MRS. CONNIE FAYE BLACKFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SP
Contact information
Practice address
607 HILLCREST DR, NEWBURGH, IN 47630-1356
(812) 453-4649
Mailing address
607 HILLCREST DR, NEWBURGH, IN 47630-1356
(812) 453-4649
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22001775A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00117481
ASHA - CCC-SLP
—
01
—
22001775A
IPLA - SPEECH PATHOLOGIST LICENSE
IN
Enumeration date
02/04/2019
Last updated
02/04/2019
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