Healthcare Provider Details

I. General information

NPI: 1447182563
Provider Name (Legal Business Name): JUDITH K BLANKENSHIP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 ROSMAN SCHOOL RD
ROSMAN NC
28772-9770
US

IV. Provider business mailing address

56 JOREE LN
BREVARD NC
28712-4216
US

V. Phone/Fax

Practice location:
  • Phone: 828-862-4431
  • Fax:
Mailing address:
  • Phone: 858-449-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12032417
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: