Healthcare Provider Details

I. General information

NPI: 1639714249
Provider Name (Legal Business Name): KAREN ANN BLOMBERG LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN ANN KINGSOLVER

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N JEFFERSON AVE
SAINT LOUIS MO
63103-3000
US

IV. Provider business mailing address

200 LILLY RD NE STE C
OLYMPIA WA
98506-5080
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone: 360-918-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number610103014
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSC610103014
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: