MEDICARE: ANGELINE BLATTENBAUER

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
2	101YM0800X	Mental Health Counselor	LH61629880	WA

General Provider Information

NPI Number	:	1679142970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELINE BLATTENBAUER

Provider Business Mailing Address
First Line	:	9800 31ST AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-4115
Country	:	US
Telephone Number	:	206-434-1462
Fax Number	:

Provider Business Practice Location Address
First Line	:	9800 31ST AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-4115
Country	:	US
Telephone Number	:	206-434-1462
Fax Number	:

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

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	03/23/2026

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Directions to “ ANGELINE BLATTENBAUER ” Practice Location

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