Healthcare Provider Details

I. General information

NPI: 1801401518
Provider Name (Legal Business Name): AMY NICHOLE BLANKS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 04/11/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DR STE 190
FRISCO CO
80443-5868
US

IV. Provider business mailing address

265 DILLON RIDGE RD STE C
DILLON CO
80435-6009
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-0888
  • Fax: 970-668-4406
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0005449
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: