Provider Demographics
NPI:1710562707
Name:ANKENBRANDT, BLAIR (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BLAIR
Middle Name:
Last Name:ANKENBRANDT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:BLAIR
Other - Middle Name:
Other - Last Name:SECORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4421 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2304
Mailing Address - Country:US
Mailing Address - Phone:989-832-9026
Mailing Address - Fax:
Practice Address - Street 1:4421 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2304
Practice Address - Country:US
Practice Address - Phone:989-832-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist