Provider Demographics
NPI:1578290656
Name:BLANKENSHIP, MELISSA JO (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JO
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 AUTUMN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7836
Mailing Address - Country:US
Mailing Address - Phone:614-563-6629
Mailing Address - Fax:
Practice Address - Street 1:456 AUTUMN RIDGE CIR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7836
Practice Address - Country:US
Practice Address - Phone:614-563-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1000320-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical