Individual
BLAIR FRESHWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2522 FORT WORTH AVE, DALLAS, TX 75211-1703
(214) 736-1632
Mailing address
17231 MARIANNE CIR, DALLAS, TX 75252-4015
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
103355
TX
Other
Enumeration date
12/08/2017
Last updated
12/08/2017
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