Provider Demographics
NPI:1881752640
Name:BLONDIN, KATHLEEN M (MSW LCSW ACSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:BLONDIN
Suffix:
Gender:F
Credentials:MSW LCSW ACSW
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:RITCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW ACSW
Mailing Address - Street 1:404 E BOONESLICK
Mailing Address - Street 2:STE B
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383
Mailing Address - Country:US
Mailing Address - Phone:636-456-7715
Mailing Address - Fax:636-456-0935
Practice Address - Street 1:404 E BOONESLICK
Practice Address - Street 2:STE B
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383
Practice Address - Country:US
Practice Address - Phone:636-456-7715
Practice Address - Fax:636-456-0935
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0016981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical