Provider Demographics
NPI:1003867797
Name:BLADUELL, HARRIET DEBRA (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HARRIET
Middle Name:DEBRA
Last Name:BLADUELL
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13542 N FLORIDA AVE
Mailing Address - Street 2:SUITE 213F
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3263
Mailing Address - Country:US
Mailing Address - Phone:813-323-5748
Mailing Address - Fax:813-319-5835
Practice Address - Street 1:13542 N FLORIDA AVE
Practice Address - Street 2:SUITE 213F
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3263
Practice Address - Country:US
Practice Address - Phone:813-323-5748
Practice Address - Fax:813-319-5835
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01041950OtherASHA CERTIFICATION NATION