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NPI Code Detail

MEDICARE: MICHELLE DAWN BLAKEMAN LCSW

MEDICARE: MICHELLE DAWN BLAKEMAN LCSW
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
1104100000XSocial WorkerS.1701354OH

General Provider Information

NPI Number : 1992224398
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE DAWN BLAKEMAN LCSW
Provider Business Mailing Address
First Line : 4309 HIGHGATE RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-5740
Country : US
Telephone Number : 146-963-1220
Fax Number :
Provider Business Practice Location Address
First Line : 4309 HIGHGATE RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-5740
Country : US
Telephone Number : 146-963-1220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2017
Last Update Date : 04/13/2022

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