Healthcare Provider Details

I. General information

NPI: 1316552730
Provider Name (Legal Business Name): BLAYKE DRURY SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 66TH ST STE D
LUBBOCK TX
79414-4875
US

IV. Provider business mailing address

4601 66TH ST STE D
LUBBOCK TX
79414-4875
US

V. Phone/Fax

Practice location:
  • Phone: 866-832-1708
  • Fax:
Mailing address:
  • Phone: 866-832-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number117346
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: