Provider Demographics
NPI:1427173756
Name:BLAISDELL, KAREN SUE (SLP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:BLAISDELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 DUNNING CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9476
Mailing Address - Country:US
Mailing Address - Phone:336-403-3859
Mailing Address - Fax:
Practice Address - Street 1:1660 CHERRY BLOSSOM LN
Practice Address - Street 2:APT. 103
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-3226
Practice Address - Country:US
Practice Address - Phone:336-403-3859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9245OtherCA STATE SLP LICENSE
NC9369OtherNORTH CAROLINA LICENSE