Provider Demographics
NPI:1235438797
Name:PARKER, BLAINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BLAINE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 ELPINE GRAY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8529
Mailing Address - Country:US
Mailing Address - Phone:901-729-6141
Mailing Address - Fax:
Practice Address - Street 1:7716 ELPINE GRAY DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-8529
Practice Address - Country:US
Practice Address - Phone:901-729-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1405235Z00000X
TN4568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist