Provider Demographics
NPI:1972833895
Name:BLAIR, CRISTINE ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:CRISTINE
Middle Name:ANN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22910 90TH AVE W UNIT E403
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-9417
Mailing Address - Country:US
Mailing Address - Phone:425-774-1424
Mailing Address - Fax:
Practice Address - Street 1:6912 220TH ST SW STE 213
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2171
Practice Address - Country:US
Practice Address - Phone:425-672-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003040235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist