Individual
CARLY BLODGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
3435 W VAN BUREN ST, CHICAGO, IL 60624-3312
(773) 826-6065
Mailing address
3435 W VAN BUREN ST, CHICAGO, IL 60624-3312
(773) 826-6065
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146014488
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146014488
ASHA LICENSE
—
Enumeration date
03/17/2020
Last updated
03/17/2020
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