Provider Demographics
NPI:1740839794
Name:BLASKO STEWART, KATHLEEN (PCC, LICDC, CEAP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BLASKO STEWART
Suffix:
Gender:F
Credentials:PCC, LICDC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12282 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3620
Mailing Address - Country:US
Mailing Address - Phone:216-375-3524
Mailing Address - Fax:
Practice Address - Street 1:8748 BRECKSVILLE RD STE 222
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1985
Practice Address - Country:US
Practice Address - Phone:216-375-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional