Provider Demographics
NPI:1972743193
Name:BLANCHARD, MIRIAM R (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:R
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:RAMIREZ
Other - Last Name:DAHUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:110 N MACLAY AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2986
Mailing Address - Country:US
Mailing Address - Phone:818-837-1000
Mailing Address - Fax:
Practice Address - Street 1:110 N MACLAY AVE
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2989
Practice Address - Country:US
Practice Address - Phone:818-837-1000
Practice Address - Fax:818-837-1005
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8627OtherSPEECH LANGUAGE PATHOLOGIST