Healthcare Provider Details

I. General information

NPI: 1457266355
Provider Name (Legal Business Name): KATIE DAWN BLAZER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 WHITE RIDGE RD
POINT PLEASANT WV
25550-3878
US

IV. Provider business mailing address

304 MILL CREEK RD
MOUNT ALTO WV
25264-9663
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-2230
  • Fax: 304-675-2234
Mailing address:
  • Phone: 304-812-5426
  • Fax: 304-812-5427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: