Provider Demographics
NPI:1700282092
Name:TRUEBLOOD, RAE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RAE
Middle Name:
Last Name:TRUEBLOOD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:RAE
Other - Middle Name:
Other - Last Name:DAILY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13005 COMMUNITY CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4000
Mailing Address - Country:US
Mailing Address - Phone:813-962-7138
Mailing Address - Fax:
Practice Address - Street 1:13005 COMMUNITY CAMPUS DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4000
Practice Address - Country:US
Practice Address - Phone:813-962-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist