MEDICARE: JESSICA DAWN BLANCHAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4512	KS

General Provider Information

NPI Number	:	1710581640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DAWN BLANCHAT

Provider Business Mailing Address
First Line	:	8247 LEAVENWORTH RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-1574
Country	:	US
Telephone Number	:	913-703-4037
Fax Number	:	888-519-1073

Provider Business Practice Location Address
First Line	:	8247 LEAVENWORTH RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-1574
Country	:	US
Telephone Number	:	913-703-4037
Fax Number	:	888-519-1073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2020
Last Update Date	:	07/11/2023

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Directions to “ JESSICA DAWN BLANCHAT ” Practice Location

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