Provider Demographics
NPI:1881865301
Name:BLODGETT, DALE MARION (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DALE
Middle Name:MARION
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 COUNTY ROAD 913
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-4641
Mailing Address - Country:US
Mailing Address - Phone:817-269-2789
Mailing Address - Fax:
Practice Address - Street 1:2316 COUNTY ROAD 913
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-4641
Practice Address - Country:US
Practice Address - Phone:817-269-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12202171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator