Healthcare Provider Details

I. General information

NPI: 1144018318
Provider Name (Legal Business Name): MEGAN BLASZAK MSW, SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 SCHOOL ST
GLENWOOD SPRINGS CO
81601-3325
US

IV. Provider business mailing address

PO BOX 1115
BASALT CO
81621-1115
US

V. Phone/Fax

Practice location:
  • Phone: 970-384-5450
  • Fax:
Mailing address:
  • Phone: 970-924-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWC.0000002046
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: