Provider Demographics
NPI:1598493173
Name:DE BLAEY, ERIC (AUD CCC-A)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:DE BLAEY
Suffix:
Gender:M
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 CHANCELLOR WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2344
Mailing Address - Country:US
Mailing Address - Phone:414-339-5263
Mailing Address - Fax:
Practice Address - Street 1:7617 CHANCELLOR WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-2344
Practice Address - Country:US
Practice Address - Phone:414-339-5263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001888231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist