Provider Demographics
NPI:1730633017
Name:BLACKMON, KOLBEE LEANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KOLBEE
Middle Name:LEANN
Last Name:BLACKMON
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 1:3013 RAZORBACK ST
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-0570
Mailing Address - Country:US
Mailing Address - Phone:214-856-0264
Mailing Address - Fax:469-545-0629
Practice Address - Street 1:3013 RAZORBACK ST
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-0570
Practice Address - Country:US
Practice Address - Phone:214-856-0264
Practice Address - Fax:469-545-0629
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist