Provider Demographics
NPI:1487886859
Name:BLANKENSHIP, SALLY ANN (MA, CCC-SP)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-244-0263
Mailing Address - Fax:530-247-0688
Practice Address - Street 1:2208 PARK MARINA DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2111
Practice Address - Country:US
Practice Address - Phone:530-244-0263
Practice Address - Fax:530-247-0688
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist