MEDICARE: ALETHEA DESHONE BLOSSOMGAME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SWI.LW.61506913	WA

General Provider Information

NPI Number	:	1487505244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALETHEA DESHONE BLOSSOMGAME

Provider Business Mailing Address
First Line	:	PO BOX 185
Second Line	:
City	:	SPANAWAY
State	:	WA
Zip	:	98387-0185
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 200TH STREET CT E
Second Line	:
City	:	SPANAWAY
State	:	WA
Zip	:	98387-8165
Country	:	US
Telephone Number	:	253-470-8060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ ALETHEA DESHONE BLOSSOMGAME ” Practice Location

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