Provider Demographics
NPI:1437558525
Name:BLUBAUGH, KATHERINE L (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:BLUBAUGH
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 1:2403 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7155
Mailing Address - Country:US
Mailing Address - Phone:479-262-9511
Mailing Address - Fax:
Practice Address - Street 1:2403 TURNER ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7155
Practice Address - Country:US
Practice Address - Phone:479-262-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8802235Z00000X
ARSP-3802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist