Basic Information
Provider Information
NPI: 1750507802
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BLOUNT
FirstName: HAL
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: M.A.,CCC-SLP-L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5074 FAWN CIR
Address2:  
City: EMMAUS
State: PA
PostalCode: 180495144
CountryCode: US
TelephoneNumber: 6102954474
FaxNumber:  
Practice Location
Address1: 2250 HICKORY RD STE 240
Address2:  
City: PLYMOUTH MEETING
State: PA
PostalCode: 194622225
CountryCode: US
TelephoneNumber: 6108341122
FaxNumber: 6108347525
Other Information
ProviderEnumerationDate: 04/17/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XSL008243PAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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