=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093683708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BLAIR DANTZ BLONQUIST LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2025
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 498 N 900 W STE 220
-----------------------------------------------------
City | KAYSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84037-4189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-603-1544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 896 BEN LOMOND AVE
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 8858731-3501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------