Provider Demographics
NPI:1477079929
Name:BLACKWELL, ASIA T (SLP)
Entity Type:Individual
Prefix:MISS
First Name:ASIA
Middle Name:T
Last Name:BLACKWELL
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 1:3916 ROXANNE RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4025
Mailing Address - Country:US
Mailing Address - Phone:443-682-5880
Mailing Address - Fax:
Practice Address - Street 1:3916 ROXANNE RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4025
Practice Address - Country:US
Practice Address - Phone:443-682-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist