Provider Demographics
NPI:1700570876
Name:BLACKLOCK, PAIGE EMILY (CF-SLP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:EMILY
Last Name:BLACKLOCK
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17020 SW UPPER BOONES FERRY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7078
Mailing Address - Country:US
Mailing Address - Phone:503-894-1539
Mailing Address - Fax:971-353-5182
Practice Address - Street 1:17020 SW UPPER BOONES FERRY RD STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7078
Practice Address - Country:US
Practice Address - Phone:503-894-1539
Practice Address - Fax:971-353-5182
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist