Provider Demographics
NPI:1801401518
Name:BLANKS, AMY NICHOLE (SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICHOLE
Last Name:BLANKS
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 1:265 DILLON RIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-6009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 PEAK ONE DR STE 190
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-5868
Practice Address - Country:US
Practice Address - Phone:970-668-0888
Practice Address - Fax:970-668-4406
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0005449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist