Provider Demographics
NPI:1760656870
Name:BLICKHAN, FRANK JASON (CADC IN JULY 2008)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:JASON
Last Name:BLICKHAN
Suffix:
Gender:M
Credentials:CADC IN JULY 2008
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BLONDEAU ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-4721
Mailing Address - Country:US
Mailing Address - Phone:319-795-6908
Mailing Address - Fax:
Practice Address - Street 1:1001 BLONDEAU ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-4721
Practice Address - Country:US
Practice Address - Phone:319-795-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)