Individual
BROOKE BLAISDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5647 GULF DR, NEW PORT RICHEY, FL 34652-4019
(813) 435-3355
Mailing address
2202 N LOIS AVE APT 1327, TAMPA, FL 33607-2559
(727) 452-2728
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
Primary
SZ11580
FL
Other
Enumeration date
12/20/2021
Last updated
09/08/2023
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