Individual
MARY BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2700 DERHAKE RD, FLORISSANT, MO 63033-3918
(314) 831-0440
Mailing address
17 ROBIN LN, FENTON, MO 63026-5665
(314) 712-6843
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
—
—
Other
Enumeration date
09/05/2024
Last updated
09/05/2024
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