Provider Demographics
NPI:1649478363
Name:BLAKSLEY, NANCY JEAN (AU)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:BLAKSLEY
Suffix:
Gender:F
Credentials:AU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 HEALTH CENTER DR
Mailing Address - Street 2:3RD FLOOR, AUDIOLOGY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2762
Mailing Address - Country:US
Mailing Address - Phone:858-939-6623
Mailing Address - Fax:858-874-2348
Practice Address - Street 1:2929 HEALTH CENTER DR
Practice Address - Street 2:3RD FLOOR, AUDIOLOGY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2762
Practice Address - Country:US
Practice Address - Phone:858-939-6623
Practice Address - Fax:858-874-2348
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1320231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist