MEDICARE: LINDA SUE BLINKMANN MSW, LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	05700	IA
2	1041C0700X	Clinical Social Worker	1353	AK
3	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346209087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA SUE BLINKMANN MSW, LISW

Provider Business Mailing Address
First Line	:	PO BOX 528
Second Line	:	ATTN: BH EMERGENCY SERVICES
City	:	BETHEL
State	:	AK
Zip	:	99559-0528
Country	:	US
Telephone Number	:	907-543-6100
Fax Number	:	907-543-6159

Provider Business Practice Location Address
First Line	:	829 CHIEF EDDIE HOFFMAN HIGHWAY
Second Line	:	SUITE 150
City	:	BETHEL
State	:	AK
Zip	:	99559-0528
Country	:	US
Telephone Number	:	907-543-6100
Fax Number	:	907-543-6159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/19/2015

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Directions to “ LINDA SUE BLINKMANN MSW, LISW” Practice Location

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