Provider Demographics
NPI:1336760578
Name:BLANDING, ALYSIA (SLP)
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:
Last Name:BLANDING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 110TH AVE SE APT 703
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1675
Mailing Address - Country:US
Mailing Address - Phone:425-435-4709
Mailing Address - Fax:
Practice Address - Street 1:7100 116TH AVE SE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98056-1107
Practice Address - Country:US
Practice Address - Phone:425-204-4087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60924675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist