MEDICARE: MRS. CHELSEA SAMANTHA BLANKS M.A., CCC-SLP

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	2202006925	VA
2	235Z00000X	Speech-Language Pathologist	SLP000578	DC

General Provider Information

NPI Number	:	1669728077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHELSEA SAMANTHA BLANKS M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	3706 FORT LINCOLN DR NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-4303
Country	:	US
Telephone Number	:	301-395-6704
Fax Number	:

Provider Business Practice Location Address
First Line	:	3706 FORT LINCOLN DR NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-4303
Country	:	US
Telephone Number	:	301-395-6704
Fax Number	:

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

Provider Enumeration Date	:	08/03/2012
Last Update Date	:	01/11/2019

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Directions to “ MRS. CHELSEA SAMANTHA BLANKS M.A., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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