Provider Demographics
NPI:1912065905
Name:BLAKEMORE, MARGARET ELLEN (MAED)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ELLEN
Last Name:BLAKEMORE
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 STATE HIGHWAY FF
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-7138
Mailing Address - Country:US
Mailing Address - Phone:573-243-7887
Mailing Address - Fax:
Practice Address - Street 1:3017 STATE HIGHWAY FF
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-7138
Practice Address - Country:US
Practice Address - Phone:573-243-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist