Healthcare Provider Details

I. General information

NPI: 1467073213
Provider Name (Legal Business Name): CHRISTOPHER BLANKENSHIP LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 MINERAL STREET UNIT A
SILVERTON CO
81433-8143
US

IV. Provider business mailing address

PO BOX 262
SILVERTON CO
81433-0262
US

V. Phone/Fax

Practice location:
  • Phone: 303-618-2115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925770
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: