Provider Demographics
NPI:1285402594
Name:WHITEHEAD, BLASI ANN
Entity type:Individual
Prefix:
First Name:BLASI
Middle Name:ANN
Last Name:WHITEHEAD
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 1:757 S STATE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4438
Mailing Address - Country:US
Mailing Address - Phone:507-238-2390
Mailing Address - Fax:
Practice Address - Street 1:757 S STATE ST STE 2
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4438
Practice Address - Country:US
Practice Address - Phone:507-238-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2930237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist