Provider Demographics
NPI:1003434168
Name:BLAIRE, LINDSAY DEANNA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:DEANNA
Last Name:BLAIRE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W LINDNER AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6837
Mailing Address - Country:US
Mailing Address - Phone:480-200-3293
Mailing Address - Fax:
Practice Address - Street 1:738 S LONGMORE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-1908
Practice Address - Country:US
Practice Address - Phone:480-472-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA111524501Medicaid