Provider Demographics
NPI:1366675514
Name:VASQUEZ, BLAIR TOLEDO (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:TOLEDO
Last Name:VASQUEZ
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 1:8639 SUNNY OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6013
Mailing Address - Country:US
Mailing Address - Phone:210-842-5893
Mailing Address - Fax:
Practice Address - Street 1:5800 BROADWAY ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5265
Practice Address - Country:US
Practice Address - Phone:210-828-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist