Provider Demographics
NPI:1194318881
Name:ENDICOTT, BLAIR (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:ENDICOTT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55878 RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-9541
Mailing Address - Country:US
Mailing Address - Phone:574-850-8702
Mailing Address - Fax:
Practice Address - Street 1:55878 RAINTREE DR
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-9541
Practice Address - Country:US
Practice Address - Phone:574-850-8702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist