Eva Mae Blakely, MS/CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Edgewood, NM
NPI 1124568035 · NPPES record last updated Feb 27, 2017
Key facts
- NPI
- 1124568035
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 6153 (NM)
- Practice address
- 1090 Mountain Valley Rd
Edgewood, NM 87015-8044 - Phone
- (505) 281-1811
- Fax
- (505) 281-7704
- NPI assigned
- Feb 27, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6153 | NM | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| THNM Skyline Therapy Services | Speech-Language Pathologist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 6153 | NM | Yes |
Addresses
Primary practice location
1090 Mountain Valley Rd
Edgewood, NM 87015-8044
Mailing address
PO Box 2225
Edgewood, NM 87015-2225
Phone (505) 281-1811
Other providers in Edgewood, NM
- Cynthia Batie
- Faith Beck
- Elizabeth Bennett
- Liza Black
- Thomas Black
- Krystal Marie Blanton
- Monica Briones
- Louis R Bush
- Sharon Carpenter
- Christie Castellanos
All providers in Edgewood, NM · Speech-Language Pathologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.