Individual
CHANEL BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
4058 MINNESOTA AVE NE, WASHINGTON, DC 20019-3540
(919) 524-9118
Mailing address
615 SWANN AVE APT 505, ALEXANDRIA, VA 22301-1464
(919) 524-9118
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP001062
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53-6001131
—
DC
Enumeration date
01/12/2018
Last updated
01/12/2018
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