Provider Demographics
NPI:1295336204
Name:BLASZKOWSKI, AMANDA (MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BLASZKOWSKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 BRISBANE CIR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5309
Mailing Address - Country:US
Mailing Address - Phone:916-221-8023
Mailing Address - Fax:
Practice Address - Street 1:9355 E STOCKTON BLVD STE 225
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9526
Practice Address - Country:US
Practice Address - Phone:916-422-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health