Provider Demographics
NPI:1023995875
Name:BLANCO, SOPHIE KATHRYN
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:KATHRYN
Last Name:BLANCO
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 1:2145 W AVENTURA WAY APT 8317
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3139
Mailing Address - Country:US
Mailing Address - Phone:618-509-2780
Mailing Address - Fax:
Practice Address - Street 1:141 WEISS RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7741
Practice Address - Country:US
Practice Address - Phone:636-851-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist