Provider Demographics
NPI:1114335817
Name:BLANKER, MARY ALICE WALKER (LMSW, CAADC, ADS)
Entity Type:Individual
Prefix:MRS
First Name:MARY ALICE
Middle Name:WALKER
Last Name:BLANKER
Suffix:
Gender:F
Credentials:LMSW, CAADC, ADS
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ALICE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CAADC, ADS
Mailing Address - Street 1:1115 BALL AVE, NE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5904
Mailing Address - Country:US
Mailing Address - Phone:616-459-7215
Mailing Address - Fax:616-451-0020
Practice Address - Street 1:1115 BALL AVE, NE
Practice Address - Street 2:BUILDING C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5904
Practice Address - Country:US
Practice Address - Phone:616-459-7215
Practice Address - Fax:616-451-0020
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010937801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical