Provider Demographics
NPI:1942917794
Name:BLEWITT, AUDRA ELISE
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:ELISE
Last Name:BLEWITT
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 1:18291 N PIMA RD STE 110-326
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5697
Mailing Address - Country:US
Mailing Address - Phone:480-401-1848
Mailing Address - Fax:480-923-0950
Practice Address - Street 1:18291 N PIMA RD STE 110-326
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5697
Practice Address - Country:US
Practice Address - Phone:480-401-1848
Practice Address - Fax:480-923-0950
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist