Provider Demographics
NPI:1780739110
Name:BLATNIK, JENNIFER KAYE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAYE
Last Name:BLATNIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23811 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5525
Mailing Address - Country:US
Mailing Address - Phone:617-420-1917
Mailing Address - Fax:
Practice Address - Street 1:23811 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5525
Practice Address - Country:US
Practice Address - Phone:617-420-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2106946104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker