Healthcare Provider Details

I. General information

NPI: 1275085318
Provider Name (Legal Business Name): LISA BLANKENSHIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S 336TH ST STE 205
FEDERAL WAY WA
98003-7354
US

IV. Provider business mailing address

9208 GRAND CORDERA PKWY
COLORADO SPRINGS CO
80924-7022
US

V. Phone/Fax

Practice location:
  • Phone: 360-488-8211
  • Fax:
Mailing address:
  • Phone: 719-522-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61488076
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: