Provider Demographics
NPI:1235765967
Name:BLANCH, CATHERINE J (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:J
Last Name:BLANCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5410
Mailing Address - Country:US
Mailing Address - Phone:816-694-1437
Mailing Address - Fax:
Practice Address - Street 1:5602 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-5410
Practice Address - Country:US
Practice Address - Phone:816-694-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190108741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical