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General NPI Number Information
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NPI Number | 1093482325
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Entity Type | Individual
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Provider Name | CARLY BLOSE
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Gender | Female
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 55 S MEADOWOOD DR
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City | NEWARK
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State | DE
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Zip | 19711-6755
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Country | US
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Telephone | 484-994-9635
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 S 12TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-5526
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Country | US
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Telephone | 484-994-9635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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