Provider Demographics
NPI:1003808775
Name:BLADES, CHERI DANIELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:DANIELLE
Last Name:BLADES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:CHERI
Other - Middle Name:DANIELLE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:50 N MEDICAL DRIVE SOM 1R73
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-2885
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DRIVE SOM 1R73
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102040235Z00000X
UT7338662-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87461TOtherSPEECH PATHOLOGIST
TX87461TOtherSPEECH PATHOLOGIST