Provider Demographics
NPI:1649367996
Name:BLACKLEY, SANDIE BARRIE (MA/CCC)
Entity type:Individual
Prefix:PROF
First Name:SANDIE
Middle Name:BARRIE
Last Name:BLACKLEY
Suffix:
Gender:F
Credentials:MA/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 CLAREMONT DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2414
Mailing Address - Country:US
Mailing Address - Phone:336-835-8224
Mailing Address - Fax:336-835-1549
Practice Address - Street 1:188 CLAREMONT DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2414
Practice Address - Country:US
Practice Address - Phone:336-835-8224
Practice Address - Fax:336-835-1549
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist