Basic Information
| Provider Information | |||||||||
| NPI: | 1801122429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANCHARD | ||||||||
| FirstName: | KACIE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1455 BATTERSBY AVE | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980223634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608028721 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1455 BATTERSBY AVE | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980223634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608028721 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2009 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | LW60347244 | 01 | WA | WA STATE DOH | OTHER |