Provider Demographics
NPI:1285052282
Name:BLAKER, KATHARINE ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:ANNE
Last Name:BLAKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:3533 RIO GRANDE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3072
Mailing Address - Country:US
Mailing Address - Phone:505-816-8434
Mailing Address - Fax:505-277-0968
Practice Address - Street 1:1700 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3835
Practice Address - Country:US
Practice Address - Phone:505-277-4453
Practice Address - Fax:505-277-0968
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM1845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist