Provider Demographics
NPI:1407554736
Name:BLANCHARD, KATIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:CHELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:200 GARDEN ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-8920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 GARDEN ST UNIT C
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-8920
Practice Address - Country:US
Practice Address - Phone:630-553-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020011313124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist