Provider Demographics
NPI:1639296908
Name:BLANCHARD, KRISTEN A (BA)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:A
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:625 N ORANGE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-2296
Mailing Address - Country:US
Mailing Address - Phone:302-656-4044
Mailing Address - Fax:302-656-3439
Practice Address - Street 1:625 N ORANGE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2296
Practice Address - Country:US
Practice Address - Phone:302-656-4044
Practice Address - Fax:302-656-3439
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE103TP2701XMedicaid