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General NPI Number Information
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NPI Number | 1982918538
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Entity Type | Individual
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Provider Name | BLAKE S SCHNEIDER LCSW, LISW
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Gender | Male
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 1111 DUFF AVE
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City | AMES
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State | IA
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Zip | 50010-5745
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Country | US
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Telephone | 515-239-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 BEAVER CREST DR
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City | DES MOINES
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State | IA
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Zip | 50310-3414
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Country | US
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Telephone | 314-456-8662
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 105997
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2007035726
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License Number State | MO
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