MEDICARE: MRS. CATHERINE SCONZO BLACKBURN M.S. 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	2095	OK

General Provider Information

NPI Number	:	1982812988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE SCONZO BLACKBURN M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	315 NW 16TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-3420
Country	:	US
Telephone Number	:	405-528-0771
Fax Number	:	405-842-5807

Provider Business Practice Location Address
First Line	:	4301 NW 63RD ST STE 304
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1504
Country	:	US
Telephone Number	:	405-858-8737
Fax Number	:	405-879-0247

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. CATHERINE SCONZO BLACKBURN M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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