Provider Demographics
NPI:1932826401
Name:BLANKENSHIP, DANIEL WILLIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:WILLIAM
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:WILLIAM
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPT
Mailing Address - Street 1:5742 OLD SALT LOOP
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7699
Mailing Address - Country:US
Mailing Address - Phone:423-933-8739
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040A JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:423-933-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0153761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical