Provider Demographics
NPI:1134762388
Name:BLANKINSHIP, CORAL LYNN (LICSW, MSW)
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:LYNN
Last Name:BLANKINSHIP
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 212TH ST SW STE 106
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7614
Mailing Address - Country:US
Mailing Address - Phone:062-852-7304
Mailing Address - Fax:
Practice Address - Street 1:7500 212TH ST SW STE 106
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7614
Practice Address - Country:US
Practice Address - Phone:206-852-7304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW612070321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW61207032OtherLICSW
WA1134762388Medicaid