Healthcare Provider Details

I. General information

NPI: 1669515581
Provider Name (Legal Business Name): KRISTI YVONNE BLAIR MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2746 SUPERIOR DR NW SUITE 300
ROCHESTER MN
55901-8343
US

IV. Provider business mailing address

5423 RIDGEWAY RD NW
ROCHESTER MN
55901-4842
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-0064
  • Fax: 507-288-3993
Mailing address:
  • Phone: 651-253-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8086
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: