Provider Demographics
NPI:1184976276
Name:BLOCK, LINDA D (MA CCC/A)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:D
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MA CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAKE FOREST BAPTIST MEDICAL CENTER
Mailing Address - Street 2:MEDICAL CENTER BLVD
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27012-1166
Mailing Address - Country:US
Mailing Address - Phone:336-716-6480
Mailing Address - Fax:336-716-7300
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-6480
Practice Address - Fax:336-716-7300
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1345231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist