Connie Faye Blackford, MA, CCC-SP
Individual provider Active NPI Speech-Language Pathologist · Newburgh, IN
NPI 1164987129 · NPPES record last updated Feb 4, 2019
Key facts
- NPI
- 1164987129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 22001775A (IN)
- Practice address
- 607 Hillcrest Dr
Newburgh, IN 47630-1356 - Phone
- (812) 453-4649
- NPI assigned
- Feb 4, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22001775A | IN | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist |
235Z00000X | 22001775A | IN | Yes |
Addresses
Primary practice location
607 Hillcrest Dr
Newburgh, IN 47630-1356
Mailing address
607 Hillcrest Dr
Newburgh, IN 47630-1356
Phone (812) 453-4649
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00117481 | Other | ASHA - CCC-SLP | |
| 22001775A | Other | IN | IPLA - SPEECH PATHOLOGIST LICENSE |
Other names
- Miss Connie Faye Lautner
Other providers in Newburgh, IN
- James R Bigham II
- Macey L Bishop
- Adrienne Renee Bittner
- Austyn Nicole Black
- Kylie Black
- Elizabeth Blackford
- Anna Nicole Blalock
- Jessica Ann Blandford
- Nathan Thomas Blandford
- Megan Marie Blankenberger
All providers in Newburgh, IN · Speech-Language Pathologist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2019. 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.