Chanel Blaylock, MS CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Washington, DC
NPI 1326556325 · NPPES record last updated May 29, 2026
Key facts
- NPI
- 1326556325
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 30003629 (NC)
- Practice address
- 4058 Minnesota Ave NE
Washington, DC 20019-3540 - Phone
- (919) 524-9118
- NPI assigned
- Jan 12, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 30003629 | NC | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 30003629 | NC | Yes |
Addresses
Primary practice location
4058 Minnesota Ave NE
Washington, DC 20019-3540
Mailing address
615 Swann Ave Apt 505
Alexandria, VA 22301-1464
Phone (919) 524-9118
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 53-6001131 | Medicaid | DC |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2026. 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.