Provider Demographics
NPI:1750857744
Name:BLANKENSHIP, KAY ELIZABETH
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:ELIZABETH
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 COUNTY ROAD 1625 E
Mailing Address - Street 2:
Mailing Address - City:CONGERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61729-9520
Mailing Address - Country:US
Mailing Address - Phone:219-869-9698
Mailing Address - Fax:
Practice Address - Street 1:100 HILLCREST DR STE E
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2227
Practice Address - Country:US
Practice Address - Phone:309-444-2800
Practice Address - Fax:309-444-2866
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health