Philip David Blalock I, SPEECH PATHOLOGIST

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

439 Issued in NC

Practice address

Wake Forest Baptist Health Medical Center Blvd
Winston Salem, NC 27157-0001

Phone

(336) 716-8207

Fax

(336) 716-8868

NPI assigned

Jan 7, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389052800000",
    "number": "1154743383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "WAKE FOREST BAPTIST HEALTH MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-8207",
            "fax_number": "336-716-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WAKE FOREST BAPTIST HEALTH MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-8207",
            "fax_number": "336-716-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLALOCK",
        "first_name": "PHILIP",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "credential": "SPEECH PATHOLOGIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-07",
        "last_updated": "2014-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khashana A Blake, MD
• Mackenzie Blake
• Timothy Carl Blake
• Gavin Douglas Blakely, RN
• Jessica Lynne Blalock, NP
• Rueben Benjamin Blancas, CRNA
• Kristi Blanco
• Kristine Kapicak Blanco, P.T.
• Deirdre R Bland, MD
• Brandon Jay Blank, PA-C

• Speech-Language Pathologist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.