Provider Demographics
NPI:1326669672
Name:BLAIR, COURTNEY (LSW)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 S SHANNON ST
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1954
Mailing Address - Country:US
Mailing Address - Phone:419-513-2600
Mailing Address - Fax:
Practice Address - Street 1:521 S SHANNON ST
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1954
Practice Address - Country:US
Practice Address - Phone:419-513-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker