Individual
AUSTIN BLACKLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8101 BOAT CLUB RD STE 160, FORT WORTH, TX 76179-3631
(214) 302-9725
Mailing address
8101 BOAT CLUB RD STE 160, FORT WORTH, TX 76179-3631
(214) 302-9725
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
116338
TX
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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