Provider Demographics
NPI:1376890061
Name:BLANKEN, KATHERINE MELISSA (MSW)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:MELISSA
Last Name:BLANKEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S ORLEANS AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2517
Mailing Address - Country:US
Mailing Address - Phone:813-417-1093
Mailing Address - Fax:
Practice Address - Street 1:514 S ORLEANS AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2517
Practice Address - Country:US
Practice Address - Phone:813-417-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor