Healthcare Provider Details

I. General information

NPI: 1568486942
Provider Name (Legal Business Name): ZANE ANDREW BLODGETT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 WANAMAKER STREET
TOPEKA KS
66610
US

IV. Provider business mailing address

4037 SW WANAMAKER RD
TOPEKA KS
66610-1347
US

V. Phone/Fax

Practice location:
  • Phone: 785-478-9170
  • Fax:
Mailing address:
  • Phone: 785-478-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002527
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: