Provider Demographics
NPI:1932489259
Name:BLACKARD, PATRICIA L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:BLACKARD
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 1:1572 COUNTY ROAD 2510
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-6819
Mailing Address - Country:US
Mailing Address - Phone:972-742-8576
Mailing Address - Fax:903-583-9400
Practice Address - Street 1:1572 COUNTY ROAD 2510
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-6819
Practice Address - Country:US
Practice Address - Phone:972-742-8576
Practice Address - Fax:903-583-9400
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4968235Z00000X
TX102393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist