Basic Information
| Provider Information | |||||||||
| NPI: | 1043879141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANTON | ||||||||
| FirstName: | TORI | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 N CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274054314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363752240 | ||||||||
| FaxNumber: | 3363752214 | ||||||||
| Practice Location | |||||||||
| Address1: | 3907 W MARKET ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274071303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362799008 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2019 | ||||||||
| LastUpdateDate: | 06/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 13423 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.