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General NPI Number Information
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NPI Number | 1447438130
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Entity Type | Individual
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Provider Name | DEBORAH JOANNE BLAYLOCK AUD
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Gender | Female
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 13090 N 94TH DR STE 202
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City | PEORIA
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State | AZ
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Zip | 85381-4258
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Country | US
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Telephone | 480-712-2206
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Fax |
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Provider Business Mailing Address
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Address Line | 9146 W VIA DEL SOL
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City | PEORIA
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State | AZ
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Zip | 85383-3544
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Country | US
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Telephone | 602-690-4108
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | DA1454
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License Number State | AZ
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