Provider Demographics
NPI:1891543138
Name:BLANKENHEIM, SOPHIE DAWN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:DAWN
Last Name:BLANKENHEIM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHESTNUT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1557
Mailing Address - Country:US
Mailing Address - Phone:508-757-2756
Mailing Address - Fax:
Practice Address - Street 1:18 CHESTNUT ST STE 200
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1557
Practice Address - Country:US
Practice Address - Phone:508-757-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASLP100514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist