Provider Demographics
NPI:1861242752
Name:BLOTSKY, KATELYN RAE (LMSW)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:RAE
Last Name:BLOTSKY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4474 24TH AVE S
Mailing Address - Street 2:#710
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-989-5467
Mailing Address - Fax:
Practice Address - Street 1:7951 JACKS WAY STE 128
Practice Address - Street 2:
Practice Address - City:HORACE
Practice Address - State:ND
Practice Address - Zip Code:58047-9002
Practice Address - Country:US
Practice Address - Phone:701-417-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33050104100000X
ND6712104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker