MEDICARE: MARYJANE BLANCHFIELD

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	603	ND
2	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22354	OTHER	ND	BCBSND
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	58301-A002	OTHER	ND	TRIWEST
4	62-56618	OTHER	ND	MEDICA UBH

General Provider Information

NPI Number	:	1881767960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYJANE BLANCHFIELD

Provider Business Mailing Address
First Line	:	7535 54TH ST NE
Second Line	:
City	:	PENN
State	:	ND
Zip	:	58362-9567
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 4TH ST NW
Second Line	:	SUITE 5
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-2960
Country	:	US
Telephone Number	:	701-662-6776
Fax Number	:	701-662-6889

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	09/11/2025

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Directions to “ MARYJANE BLANCHFIELD ” Practice Location

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