Provider Demographics
NPI:1114209509
Name:BLATTNER, AMBER EVELYN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:EVELYN
Last Name:BLATTNER
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 1:15140 238TH RD
Mailing Address - Street 2:
Mailing Address - City:CUMMINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66016-9034
Mailing Address - Country:US
Mailing Address - Phone:913-367-5549
Mailing Address - Fax:
Practice Address - Street 1:3007 S BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-1546
Practice Address - Country:US
Practice Address - Phone:816-387-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011013597235Z00000X
KS2888235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist