Healthcare Provider Details

I. General information

NPI: 1982918538
Provider Name (Legal Business Name): BLAKE S SCHNEIDER LCSW, LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DUFF AVE
AMES IA
50010-5745
US

IV. Provider business mailing address

4121 BEAVER CREST DR
DES MOINES IA
50310-3414
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-2662
  • Fax:
Mailing address:
  • Phone: 314-456-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105997
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2007035726
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: