Provider Demographics
NPI:1235688276
Name:BLAISDELL, GERRI LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:GERRI
Middle Name:LEE
Last Name:BLAISDELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:GERRI
Other - Middle Name:LEE
Other - Last Name:SPRECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:KS
Mailing Address - Zip Code:66835-9676
Mailing Address - Country:US
Mailing Address - Phone:620-412-1709
Mailing Address - Fax:
Practice Address - Street 1:1319 W MAY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3505
Practice Address - Country:US
Practice Address - Phone:316-267-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9547104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker