Provider Demographics
NPI:1801828298
Name:BLAYDES, KAREN TERESE (SLP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:TERESE
Last Name:BLAYDES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1214
Mailing Address - Country:US
Mailing Address - Phone:407-340-0319
Mailing Address - Fax:321-400-1290
Practice Address - Street 1:900 WEST ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1214
Practice Address - Country:US
Practice Address - Phone:407-340-0319
Practice Address - Fax:321-400-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77101235Z00000X
FLSA8587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist