Provider Demographics
NPI:1043044506
Name:BRUNSON, BLAIR REED (SLP)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:REED
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 N ACADEMY BLVD STE 3300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4082
Mailing Address - Country:US
Mailing Address - Phone:888-701-9216
Mailing Address - Fax:866-569-1087
Practice Address - Street 1:5265 N ACADEMY BLVD STE 3300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4082
Practice Address - Country:US
Practice Address - Phone:888-701-9216
Practice Address - Fax:866-569-1087
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0001343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist