Individual
MRS. AMY A BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-A
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 412-7804
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 412-7804
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
0969A
AL
Other
Enumeration date
01/30/2006
Last updated
12/19/2011
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