Provider Demographics
NPI:1154528347
Name:BLANDFORD, NANETTE ANN (SPEECH THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:NANETTE
Middle Name:ANN
Last Name:BLANDFORD
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1668
Mailing Address - Street 2:815 TRIPLETT ST
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1668
Mailing Address - Country:US
Mailing Address - Phone:270-683-4517
Mailing Address - Fax:270-852-1491
Practice Address - Street 1:815 TRIPLETT ST
Practice Address - Street 2:WENDELL FOSTERS CAMPUS FOR DEVELOPMENTAL DISABILITIES
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-683-4517
Practice Address - Fax:270-852-1491
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45118379Medicaid
KY33000035OtherMEDICAID SCL
KY11903135OtherMEDICAID ICF
KY45118379Medicaid