1902245905 NPI number — MS. GWENDOLYN K BLANKENSHIP LCSW

Table of content: MS. GWENDOLYN K BLANKENSHIP LCSW (NPI 1902245905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902245905 NPI number — MS. GWENDOLYN K BLANKENSHIP LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANKENSHIP
Provider First Name:
GWENDOLYN
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REED
Provider Other First Name:
GWENDOLYN
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902245905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 MEMORY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-851-1405
Provider Business Mailing Address Fax Number:
717-851-6969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
344 N READING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17522-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-738-1125
Provider Business Practice Location Address Fax Number:
717-738-0606
Provider Enumeration Date:
06/24/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904004052 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CW018315 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103626033 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12571606 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: C06778 . This is a "GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: CW018315 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".