Active NPI
Shelley Blanco
- Speech-Language Pathologist
- Montgomery, TX
National Provider Identifier
1194120949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 108029
- Practice address
- 115 Stones Edge Dr
Montgomery, TX 77356-9053 - Phone
- (972) 213-8670
- NPI assigned
- Oct 22, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 108029 | TX | Primary |
| Speech-Language Pathologist | 235Z00000X | SLP10374 | AZ |
Addresses
Primary practice location
115 Stones Edge Dr
Montgomery, TX 77356-9053
Mailing address
115 Stones Edge Dr
Montgomery, TX 77356-9053
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP10374 | AZ | MD | Speech-Language Pathologist |
| 108029 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483833600000",
"number": "1194120949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 STONES EDGE DR",
"city": "MONTGOMERY",
"state": "TX",
"postal_code": "773569053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 STONES EDGE DR",
"city": "MONTGOMERY",
"state": "TX",
"postal_code": "773569053",
"telephone_number": "972-213-8670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANCO",
"first_name": "SHELLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-22",
"last_updated": "2017-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "108029",
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "SLP10374",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.