Provider Demographics
NPI:1164718243
Name:MARYLOUISE BLOND SLP-PC
Entity Type:Organization
Organization Name:MARYLOUISE BLOND SLP-PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYLOUISE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLOND
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:516-937-0475
Mailing Address - Street 1:30 MARTIN PL
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6714
Mailing Address - Country:US
Mailing Address - Phone:516-937-0475
Mailing Address - Fax:516-937-0475
Practice Address - Street 1:30 MARTIN PL
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6714
Practice Address - Country:US
Practice Address - Phone:516-937-0475
Practice Address - Fax:516-937-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004222-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty