Provider Demographics
NPI:1003124090
Name:BLAIR-KNIGHT, PERSEPHONE (M ED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PERSEPHONE
Middle Name:
Last Name:BLAIR-KNIGHT
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 SW 153RD CT APT 6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2721
Mailing Address - Country:US
Mailing Address - Phone:305-383-3710
Mailing Address - Fax:
Practice Address - Street 1:9280 HAMMOCKS BLVD
Practice Address - Street 2:SUITE # 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1507
Practice Address - Country:US
Practice Address - Phone:305-385-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 11422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003023700Medicaid