Provider Demographics
NPI:1669638748
Name:BLANKENSHIP, KELLY (SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4314
Mailing Address - Country:US
Mailing Address - Phone:336-375-2240
Mailing Address - Fax:336-375-2214
Practice Address - Street 1:2500 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4314
Practice Address - Country:US
Practice Address - Phone:336-375-2240
Practice Address - Fax:336-375-2214
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist