Provider Demographics
NPI:1386765295
Name:BLAHUT, INGRID
Entity type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:
Last Name:BLAHUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40W325 CARL SANDBURG RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7737
Mailing Address - Country:US
Mailing Address - Phone:630-513-5012
Mailing Address - Fax:630-513-1957
Practice Address - Street 1:2422 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1010
Practice Address - Country:US
Practice Address - Phone:630-513-5012
Practice Address - Fax:630-513-1957
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist