Healthcare Provider Details

I. General information

NPI: 1023341773
Provider Name (Legal Business Name): REBECCA BLANKENHORN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 CENTER ST. SUITE A
MOBILE AL
36604
US

IV. Provider business mailing address

1610 CENTER ST. SUITE A
MOBILE AL
36604
US

V. Phone/Fax

Practice location:
  • Phone: 251-432-4560
  • Fax:
Mailing address:
  • Phone: 404-616-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD003828
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1119A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: