Provider Demographics
NPI:1013173731
Name:BLAKENEY, CLAYTON CLARK (MS, CCC/A)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:CLARK
Last Name:BLAKENEY
Suffix:
Gender:M
Credentials:MS, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 N JOSEY LN
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2474
Mailing Address - Country:US
Mailing Address - Phone:972-394-4370
Mailing Address - Fax:
Practice Address - Street 1:3740 N JOSEY LN
Practice Address - Street 2:SUITE 125
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2474
Practice Address - Country:US
Practice Address - Phone:972-394-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51428237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter