Eric John Blickenstaff, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L4669 Issued in OR

Practice address

891 NW Grant Ave
Corvallis, OR 97330-4539

Phone

(503) 708-6190

NPI assigned

May 25, 2011

Sex

Male

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": "1306281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306281600000",
    "number": "1366735227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4067 DAVIDSON ST SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973226325",
            "telephone_number": "503-708-6190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "891 NW GRANT AVE",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973304539",
            "telephone_number": "503-708-6190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLICKENSTAFF",
        "first_name": "ERIC",
        "middle_name": "JOHN",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-25",
        "last_updated": "2011-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L4669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Howard Blatt, M.D.
• Diana Rebecca Blatt
• Miyuki Blatt
• Katy Lynne Blaustein
• Phillip Francis Blea, LCSW
• Forrest Bliss, DO
• Katelyn Elizabeth Bliven
• Christopher Michael Bloom, CADC I
• James Blount
• Rheannon Rua Blount, MCOUN

• Clinical Social Worker in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2011; 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.