Provider Demographics
NPI:1467667840
Name:BLANKENSHIP, JENNIFER RACHELLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RACHELLE
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RACHELLE
Other - Last Name:MALLOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:531 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS NATIONAL PARK
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8348
Mailing Address - Country:US
Mailing Address - Phone:870-500-6015
Mailing Address - Fax:
Practice Address - Street 1:531 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS NATIONAL PARK
Practice Address - State:AR
Practice Address - Zip Code:71901-8348
Practice Address - Country:US
Practice Address - Phone:870-500-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist