Mary Blenkinsop, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP009266 Issued in GA

Practice address

4212 Coral Park Dr
Brunswick, GA 31520-3016

Phone

(912) 996-2069

Fax

(912) 265-0041

NPI assigned

Aug 8, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mary Barksdale Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Therapies of SE Ga, LLC

  • Pediatric Occupational Therapist
  • Kingsland, GA
  • NPI 1710346267
  NPD (past)
• Pediatric Therapies of SE Ga, LLC

  • Pediatric Occupational Therapist
  • Brunswick, GA
  • NPI 1841577111

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533686400000",
    "number": "1013496330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4212 CORAL PARK DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315203016",
            "telephone_number": "912-996-2069",
            "fax_number": "912-265-0041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 CORAL PARK DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315203016",
            "telephone_number": "912-996-2069",
            "fax_number": "912-265-0041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1204 Hospitality Ave Ste E",
            "address_purpose": "LOCATION",
            "city": "Kingsland",
            "state": "GA",
            "postal_code": "315486811",
            "country_code": "US",
            "telephone_number": "912-996-2069",
            "fax_number": "912-265-0041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLENKINSOP",
        "first_name": "MARY",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-08",
        "last_updated": "2018-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP009266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "BARKSDALE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Karen Blake
• Jaylee Danielle Blalock
• John Carroll Bland, RPH
• Linda M Bland, RPH
• Amanda Rostron Blankinship, CRNA
• Ashley Blizzard, RN
• Blossom & Bloom ABA
• John Blumer, M.D.
• Jimmy Mack Boatright, RPH
• Tracie Bock, RD, LD

• Speech-Language Pathologist in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.