Individual
MISS ASIA T BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3916 ROXANNE RD, RANDALLSTOWN, MD 21133-4025
(443) 682-5580
Mailing address
3916 ROXANNE RD, RANDALLSTOWN, MD 21133-4025
(443) 682-5880
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
08410
MD
Other
Enumeration date
08/16/2017
Last updated
07/21/2022
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