Individual
SHANNON EVELYN BLANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.ED., BCBA
Contact information
Practice address
1237 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(762) 685-4340
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
(407) 915-7258
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-30037
—
Other
Enumeration date
04/25/2018
Last updated
09/30/2019
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