Provider Demographics
NPI:1659406247
Name:BLAKEMORE, CINDY L
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:BLAKEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-2655
Mailing Address - Country:US
Mailing Address - Phone:816-521-2700
Mailing Address - Fax:816-521-2999
Practice Address - Street 1:INDEPENDENCE 30 SCHOOL DISTRICT
Practice Address - Street 2:218 N PLEASANT ST
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-2655
Practice Address - Country:US
Practice Address - Phone:816-521-2700
Practice Address - Fax:816-521-2999
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO463064600Medicaid