Provider Demographics
NPI:1437554870
Name:BLANKLEY, ANGELIA (PLMHP)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:
Last Name:BLANKLEY
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:ANGELIA
Other - Middle Name:
Other - Last Name:CRANDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2201 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:770 N COTNER BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2377
Practice Address - Country:US
Practice Address - Phone:402-417-6909
Practice Address - Fax:844-848-7537
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NE11899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker