Provider Demographics
NPI:1578562641
Name:STUDLEY, BLAKE A (AUD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:A
Last Name:STUDLEY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 ORLEANS DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3407
Mailing Address - Country:US
Mailing Address - Phone:308-382-4282
Mailing Address - Fax:308-381-2150
Practice Address - Street 1:659 ORLEANS DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3407
Practice Address - Country:US
Practice Address - Phone:308-382-4282
Practice Address - Fax:308-381-2150
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE241231H00000X
NE066237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter