Provider Demographics
NPI:1467086199
Name:BLANKENSHIP, CARRIE BETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:BETH
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:127 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8500
Mailing Address - Country:US
Mailing Address - Phone:859-684-7837
Mailing Address - Fax:
Practice Address - Street 1:127 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8500
Practice Address - Country:US
Practice Address - Phone:859-684-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist