Provider Demographics
NPI:1538775036
Name:BLANKENSHIP, KATHRYN BLAIR
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:BLAIR
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 1:1045 S BIRCH ST APT 321
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2548
Mailing Address - Country:US
Mailing Address - Phone:870-706-9327
Mailing Address - Fax:
Practice Address - Street 1:1724 N GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1206
Practice Address - Country:US
Practice Address - Phone:303-237-6865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty