MEDICARE: MICHELLE ASHLEY BLANKENSHIP

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1578907531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ASHLEY BLANKENSHIP

Provider Business Mailing Address
First Line	:	10116 36TH AVENUE CT SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-4791
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10116 36TH AVENUE CT SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-4791
Country	:	US
Telephone Number	:	360-489-5977
Fax Number	:

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

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/22/2013

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