Provider Demographics
NPI:1841538048
Name:BLANCO, TRICIA LYNN (SLPA)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:LYNN
Last Name:BLANCO
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:LYNN
Other - Last Name:RAWLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9149
Mailing Address - Country:US
Mailing Address - Phone:360-332-0236
Mailing Address - Fax:360-332-0555
Practice Address - Street 1:770 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-9149
Practice Address - Country:US
Practice Address - Phone:360-332-0236
Practice Address - Fax:360-332-0555
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP 602123002355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant