Provider Demographics
NPI:1689150450
Name:ARMSTRONG, BLAIR LESLIE DEJEAN (RBT)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:LESLIE DEJEAN
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 NE BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155
Mailing Address - Country:US
Mailing Address - Phone:816-368-8120
Mailing Address - Fax:800-687-5070
Practice Address - Street 1:248 NE BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155
Practice Address - Country:US
Practice Address - Phone:816-368-8120
Practice Address - Fax:800-687-5070
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180247042355S0801X
MOBRT-20-137697106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018024704Medicaid