MEDICARE: HALLI RENAE BLANCHARD LSW

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	390200000X	Student in an Organized Health Care Education/Training Program
2	104100000X	Social Worker	S.2512684	OH
3	172V00000X	Community Health Worker		OH

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

General Provider Information

NPI Number	:	1609628650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLI RENAE BLANCHARD LSW

Provider Business Mailing Address
First Line	:	23811 CHAGRIN BLVD STE 105
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5525
Country	:	US
Telephone Number	:	216-483-1001
Fax Number	:	216-283-3901

Provider Business Practice Location Address
First Line	:	23811 CHAGRIN BLVD STE 105
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5525
Country	:	US
Telephone Number	:	216-483-1001
Fax Number	:

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

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/06/2026

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Directions to “ HALLI RENAE BLANCHARD LSW” Practice Location

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