MEDICARE: KATY BLESSUM CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	SLP4132	AZ

General Provider Information

NPI Number	:	1932226800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATY BLESSUM CCC-SLP

Provider Business Mailing Address
First Line	:	9411 E PLATA AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-1465
Country	:	US
Telephone Number	:	480-326-6020
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 N RED MTN
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-1068
Country	:	US
Telephone Number	:	480-472-8750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	05/27/2025

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Directions to “ KATY BLESSUM CCC-SLP” Practice Location

Language	Start Address	Practice Location

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