Doctor Name: | JACQUELINE BLANKENSHIP |
NPI Number: | 1275928996 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.C.D., CCC-SLP |
License Number: | SA6528 |
Business Practice Address: | 8451 Us Highway 301 S Riverview, FL - 335785441 |
Business Phone Number: | 8664509927 |
Business Fax Number: | |
Mailing Address: | 200 78th Ave N Apt 183, SAINT PETERSBURG |
State: | FL |
Postal Code: | 337024469 |
Phone Number: | 8134950186 |
Fax Number: | |
NPI Enumeration Date: | 03/31/2015 |
NPI Last Update Date: | 03/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA6528 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |