Provider Demographics
NPI:1952679938
Name:BLAIR, CAROL A (MS/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:BLAIR
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 1:5892 OLD LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9713
Mailing Address - Country:US
Mailing Address - Phone:716-627-7348
Mailing Address - Fax:
Practice Address - Street 1:5892 OLD LAKE SHORE RD
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:NY
Practice Address - Zip Code:14085-9713
Practice Address - Country:US
Practice Address - Phone:716-627-7348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist