Angela Beanblossom, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34004306A Issued in IN

Practice address

289 Ireland Ave
Meddac BLDG 851 RM 9-40
Fort Knox, KY 40121-5111

Phone

(502) 624-9006

NPI assigned

Feb 21, 2011

Sex

Female

Sole proprietor

No

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)

Enrolled

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

{
    "created_epoch": "1298246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298246400000",
    "number": "1487951893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4329 W MOUNT CARMEL RD",
            "city": "SALEM",
            "state": "IN",
            "postal_code": "471678258",
            "telephone_number": "812-472-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 IRELAND AVE",
            "address_2": "MEDDAC BLDG 851 RM 9-40",
            "city": "FORT KNOX",
            "state": "KY",
            "postal_code": "401215111",
            "telephone_number": "502-624-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEANBLOSSOM",
        "first_name": "ANGELA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-21",
        "last_updated": "2011-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34004306A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Raymond Bales, ATC
• Geoffrey S. Ball, D.M.D.
• Kathryn Maria Barger, LCSW, CADC
• Daniel Joseph Bartz, PA-C
• Jerry George Baumgartner, DDS
• Kayla Beekman
• Steven Wayne Binkley, DMD
• Richard Edward Borders, D.M.D.
• Laura Elizabeth Bottoms, RDN, LD
• Bankole O Botu, M.D.

• All providers in Fort Knox, KY
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.