Organization
BLANK SLATE BEHAVIOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LEE BLANKENSHIP M.S.ED, BCBA (CEO)
(303) 505-9906
Entity
Organization
Contact information
Practice address
42 S HOLMAN WAY APT 3F, GOLDEN, CO 80401-5155
(303) 505-9906
Mailing address
42 S HOLMAN WAY APT 3F, GOLDEN, CO 80401-5155
(303) 505-9906
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811294408
—
CO
Enumeration date
08/01/2019
Last updated
08/01/2019
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