Provider Demographics
NPI:1982812988
Name:BLACKBURN, CATHERINE SCONZO (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:SCONZO
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3420
Mailing Address - Country:US
Mailing Address - Phone:405-528-0771
Mailing Address - Fax:405-842-5807
Practice Address - Street 1:4301 NW 63RD ST STE 304
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1504
Practice Address - Country:US
Practice Address - Phone:405-858-8737
Practice Address - Fax:405-879-0247
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist