Active NPI
Mary Blaylock
- Speech-Language Assistant
- Florissant, MO
National Provider Identifier
1194550566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- Practice address
- 2700 Derhake Rd
Florissant, MO 63033-3918 - Phone
- (314) 831-0440
- NPI assigned
- Sep 5, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Assistant | 2355S0801X | Primary |
Addresses
Primary practice location
2700 Derhake Rd
Florissant, MO 63033-3918
Mailing address
17 Robin LN
Fenton, MO 63026-5665
Phone (314) 712-6843
Other practice location 1
955 Derhake Rd
Florissant, MO 63033-5931
Phone (314) 831-4633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725494400000",
"number": "1194550566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 ROBIN LN",
"city": "FENTON",
"state": "MO",
"postal_code": "630265665",
"telephone_number": "314-712-6843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 DERHAKE RD",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630333918",
"telephone_number": "314-831-0440"
}
],
"practiceLocations": [
{
"address_1": "955 Derhake Rd",
"address_purpose": "LOCATION",
"city": "Florissant",
"state": "MO",
"postal_code": "630335931",
"country_code": "US",
"telephone_number": "314-831-4633",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLAYLOCK",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-05",
"last_updated": "2024-09-05",
"certification_date": "2024-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florissant, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.