Individual
KELLY BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
126 WESTERN AVE # 123, AUGUSTA, ME 04330-7249
(207) 830-1380
Mailing address
126 WESTERN AVE # 123, AUGUSTA, ME 04330-7249
(207) 830-1380
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP2350
ME
235Z00000X
Speech-Language Pathologist
ST2194
ME
Other
Enumeration date
07/30/2012
Last updated
01/03/2022
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