Provider Demographics
NPI:1184117749
Name:BLAIKNER, BIANCA RAE (LADC, LCMHC)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:RAE
Last Name:BLAIKNER
Suffix:
Gender:F
Credentials:LADC, LCMHC
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 617
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05453-0617
Mailing Address - Country:US
Mailing Address - Phone:802-734-3312
Mailing Address - Fax:
Practice Address - Street 1:172 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1743
Practice Address - Country:US
Practice Address - Phone:802-488-6900
Practice Address - Fax:802-488-6919
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0129115101YA0400X
VT068.0124899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty