Provider Demographics
NPI:1225361611
Name:BLACKBURN, BRIDGETTE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MALONEY WAY
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9553
Mailing Address - Country:US
Mailing Address - Phone:859-498-0011
Mailing Address - Fax:859-498-5001
Practice Address - Street 1:113 MALONEY WAY
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9553
Practice Address - Country:US
Practice Address - Phone:859-498-0011
Practice Address - Fax:859-498-5001
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2897235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist