Provider Demographics
NPI:1437375540
Name:BLASSINGAME, DEBORAH GALE
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:GALE
Last Name:BLASSINGAME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W UPSAL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-4039
Mailing Address - Country:US
Mailing Address - Phone:267-226-3029
Mailing Address - Fax:
Practice Address - Street 1:125 W SCHOOL HOUSE LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3348
Practice Address - Country:US
Practice Address - Phone:215-844-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005254L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist