MEDICARE: LOUELLEN BLANKINSHIP 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	109261	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750775409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUELLEN BLANKINSHIP SLP

Provider Business Mailing Address
First Line	:	10867 SAKONNET RIVER DR APT 101
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2976
Country	:	US
Telephone Number	:	417-499-5922
Fax Number	:

Provider Business Practice Location Address
First Line	:	10867 SAKONNET RIVER DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3374
Country	:	US
Telephone Number	:	417-499-5922
Fax Number	:

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

Provider Enumeration Date	:	03/20/2015
Last Update Date	:	08/14/2015

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Directions to “ LOUELLEN BLANKINSHIP SLP” Practice Location

Language	Start Address	Practice Location

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