Jettie A. Blanton, MSW, LCSW
Individual provider Active NPI Clinical Social Worker · Kingman, AZ
NPI 1275868952 · NPPES record last updated Sep 13, 2022
Key facts
- NPI
- 1275868952
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 12845 (AZ)
- Practice address
- 1741 Sycamore Ave
Kingman, AZ 86409-0927 - Phone
- (928) 757-8111
- Fax
- (928) 757-1199
- NPI assigned
- Oct 13, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 12845 | AZ | Yes |
Addresses
Primary practice location
1741 Sycamore Ave
Kingman, AZ 86409-0927
Mailing address
3707 N Stockton Hill Rd Ste B
Kingman, AZ 86409-0507
Phone (928) 757-8111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 468913 | Medicaid | AZ |
Other providers in Kingman, AZ
- BHSM Rehabilitation, LLC
- Diane Michele Bickle
- Bio-Medical Applications of Arizona, LLC
- Jeremy Bird
- Erin E. Black
- David M Bleiler
- Melaina Zanele Blomenkamp
- Kale D Bodily
- S Ismail Ah Bokhari Sr.
- Madhumitha Bolineni
All providers in Kingman, AZ · Clinical Social Worker in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.