Provider Demographics
NPI:1033707138
Name:BLACKWELL, KIRSTEN ELIZABETH TITZE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ELIZABETH TITZE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:KIRSTEN
Other - Middle Name:ELIZABETH
Other - Last Name:TITZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:401 9TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201
Mailing Address - Country:US
Mailing Address - Phone:605-882-7676
Mailing Address - Fax:605-882-7990
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201
Practice Address - Country:US
Practice Address - Phone:605-882-7700
Practice Address - Fax:605-882-7990
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD870-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist