Provider Demographics
NPI:1063031383
Name:BLANKENSHIP, AIMEE LYNN (CDCA)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:LYNN
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:LYNN
Other - Last Name:TENNANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:115 W. STATE STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:45872
Mailing Address - Country:US
Mailing Address - Phone:419-216-2888
Mailing Address - Fax:419-740-7323
Practice Address - Street 1:115 W STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:45872-1332
Practice Address - Country:US
Practice Address - Phone:833-216-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0399755Medicaid