Healthcare Provider Details

I. General information

NPI: 1255398855
Provider Name (Legal Business Name): SUSAN MICHELLE BLANCHARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER ATTN: MCEUL-DCCS (CREDENTIALS), CMR 402
APO AE
09180
US

IV. Provider business mailing address

CMR 427 BOX 3899
APO AE
09630
US

V. Phone/Fax

Practice location:
  • Phone: 44-471-7604
  • Fax:
Mailing address:
  • Phone: 44-471-7604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: