Provider Demographics
NPI:1841570637
Name:BLANCHARD, MARIA L (CSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2096
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84603-2096
Mailing Address - Country:US
Mailing Address - Phone:801-636-0165
Mailing Address - Fax:
Practice Address - Street 1:315 S 100 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-4649
Practice Address - Country:US
Practice Address - Phone:801-851-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4825018-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical