Provider Demographics
NPI:1265073431
Name:BLANC, ANN-MARIE
Entity type:Individual
Prefix:MS
First Name:ANN-MARIE
Middle Name:
Last Name:BLANC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S GRAND HWY APT 104C
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2724
Mailing Address - Country:US
Mailing Address - Phone:917-907-0748
Mailing Address - Fax:
Practice Address - Street 1:840 S GRAND HWY APT 104C
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2724
Practice Address - Country:US
Practice Address - Phone:917-907-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst