Active NPI
Tanya Marie Blackshear, LCSW, LIFE COACH
- Clinical Social Worker
- Champaign, IL
National Provider Identifier
1598068843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.016668
- Practice address
- 3347 Stoneway CT
Champaign, IL 61822-2404 - Phone
- (217) 721-3062
- NPI assigned
- Dec 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.016668 | IL | Primary |
Addresses
Primary practice location
3347 Stoneway CT
Champaign, IL 61822-2404
Mailing address
3347 Stoneway CT
Champaign, IL 61822-2404
Phone (217) 721-3062
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.016668 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405296000000",
"number": "1598068843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3347 STONEWAY CT",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618222404",
"telephone_number": "217-721-3062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3347 STONEWAY CT",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618222404",
"telephone_number": "217-721-3062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKSHEAR",
"first_name": "TANYA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "LCSW, LIFE COACH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-12-08",
"last_updated": "2014-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.016668",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.