Provider Demographics
NPI:1669728077
Name:BLANKS, CHELSEA SAMANTHA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:SAMANTHA
Last Name:BLANKS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 FORT LINCOLN DR NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-4303
Mailing Address - Country:US
Mailing Address - Phone:301-395-6704
Mailing Address - Fax:
Practice Address - Street 1:3706 FORT LINCOLN DR NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4303
Practice Address - Country:US
Practice Address - Phone:301-395-6704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006925235Z00000X, 235Z00000X
DCSLP000578235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist