Jettie A. Blanton, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12845 Issued in AZ

Practice address

1741 Sycamore Ave
Kingman, AZ 86409-0927

Phone

(928) 757-8111

Fax

(928) 757-1199

NPI assigned

Oct 13, 2009

Last updated

Sep 13, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1275868952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 N STOCKTON HILL RD STE B",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864090507",
            "telephone_number": "928-757-8111",
            "fax_number": "928-757-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1741 SYCAMORE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864090927",
            "telephone_number": "928-757-8111",
            "fax_number": "928-757-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANTON",
        "first_name": "JETTIE",
        "middle_name": "A.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-13",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "12845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BHSM Rehabilitation, LLC (Banner Physical Therapy)
• Diane Michele Bickle, CPNP
• Bio-Medical Applications of Arizona, LLC (Fresenius Medical Care Kingman)
• Jeremy Bird
• Erin E. Black, FNP-C
• David M Bleiler, D.C.
• Melaina Zanele Blomenkamp, PA-C
• Kale D Bodily, MD
• S Ismail Ah Bokhari Sr., M.D.
• Madhumitha Bolineni, MD

• Clinical Social Worker in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.