Individual
KAYLA BLOCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 HOLLAND AVE, PHILADELPHIA, MS 39350-2161
(601) 663-1296
Mailing address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3672
MS
Other
Enumeration date
06/19/2012
Last updated
06/19/2012
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