Individual
MRS. CONNIE SUE BLOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA/CCC-SLP
Contact information
Practice address
903 NE PHEASANT LN, LAWTON, OK 73507-2328
(580) 355-9230
Mailing address
903 NE PHEASANT LN, LAWTON, OK 73507-2328
(580) 355-9230
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
411
OK
Other
Enumeration date
10/19/2006
Last updated
07/09/2007
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