Provider Demographics
NPI:1578856282
Name:BLACKWELL, KALIHAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KALIHAH
Middle Name:
Last Name:BLACKWELL
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 1:4951 LADY OF THE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3079
Mailing Address - Country:US
Mailing Address - Phone:919-995-1321
Mailing Address - Fax:
Practice Address - Street 1:4951 LADY OF THE LAKE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3079
Practice Address - Country:US
Practice Address - Phone:919-995-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist