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General NPI Number Information
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NPI Number | 1851542997
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Entity Type | Organization
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Legal Business Name | BLANKENSHIP SPEECH PATHOLOGY SERVICES
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 207 1/2 MAIN ST
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City | CROSSETT
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State | AR
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Zip | 71635-2925
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Country | US
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Telephone | 870-364-1581
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Fax | 870-364-1582
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Provider Business Mailing Address
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Address Line | 3179 HIGHWAY 169 S
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City | CROSSETT
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State | AR
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Zip | 71635-9155
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Country | US
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Telephone | 870-364-1581
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Fax | 870-364-1582
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MRS. JENNIFER R BLANKENSHIP
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Credential | MCD, CCC-SLP
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Telephone | 870-364-1581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP#2400
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License Number State | AR
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