Provider Demographics
NPI:1639714249
Name:BLOMBERG, KAREN ANN (MSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:BLOMBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:KINGSOLVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 LILLY RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5080
Mailing Address - Country:US
Mailing Address - Phone:360-918-8336
Mailing Address - Fax:
Practice Address - Street 1:200 LILLY RD NE STE C
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5080
Practice Address - Country:US
Practice Address - Phone:360-918-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA610103014101YM0800X
104100000X
WASC610103014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker