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NPI Code Detail

MEDICARE: KATIE BRIANNA VANBLARICUM

MEDICARE: KATIE BRIANNA VANBLARICUM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1285147959
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE BRIANNA VANBLARICUM
Provider Business Mailing Address
First Line : 1367 E IL 250
Second Line :
City : NOBLE
State : IL
Zip : 62868-2400
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 701 SHADWELL AVE
Second Line :
City : FLORA
State : IL
Zip : 62839-2310
Country : US
Telephone Number : 618-662-8361
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2017
Last Update Date : 11/15/2017

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Directions to “ KATIE BRIANNA VANBLARICUM ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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