Healthcare Provider Details

I. General information

NPI: 1639503741
Provider Name (Legal Business Name): KATHERINE ANN BLESSING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 LAKEVIEW RD SPECIAL SERVICES
MEXICO MO
65265-1358
US

IV. Provider business mailing address

2101 LAKEVIEW RD SPECIAL SERVICES
MEXICO MO
65265-1358
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-3773
  • Fax: 573-581-1794
Mailing address:
  • Phone: 573-581-3773
  • Fax: 573-581-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: