Provider Demographics
NPI:1790457240
Name:BLANKENSHIP, BROOKE ASHLEY
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ASHLEY
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROSSI CIR
Mailing Address - Street 2:SUITE 141
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-2362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:82 TABLE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3578
Practice Address - Country:US
Practice Address - Phone:530-538-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2025-09-15
Deactivation Date:2025-08-05
Deactivation Code:
Reactivation Date:2025-09-15
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
172V00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician