Provider Demographics
NPI:1558715656
Name:BLAUFARB, BLAIRE (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:BLAIRE
Middle Name:
Last Name:BLAUFARB
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:BLAIRE
Other - Middle Name:
Other - Last Name:SPOONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1035 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-3133
Mailing Address - Country:US
Mailing Address - Phone:484-919-1338
Mailing Address - Fax:
Practice Address - Street 1:1035 WOOD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3133
Practice Address - Country:US
Practice Address - Phone:484-919-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist